Provider Demographics
NPI:1568153435
Name:SMITH, ERIC LEVERN SR (MENTAL HEALTH COUNS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEVERN
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:MENTAL HEALTH COUNS
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:LEVERN
Other - Last Name:SMITH
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL THERAPIST
Mailing Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8903
Mailing Address - Country:US
Mailing Address - Phone:843-347-4888
Mailing Address - Fax:843-347-4102
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-4888
Practice Address - Fax:843-347-4102
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-A-31267101YA0400X
NC31327101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral