Provider Demographics
NPI:1578255105
Name:SMITHLEY, MIA JO (LCASA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:JO
Last Name:SMITHLEY
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 GRESHAM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3757
Mailing Address - Country:US
Mailing Address - Phone:919-977-5993
Mailing Address - Fax:
Practice Address - Street 1:3209 GRESHAM LAKE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3757
Practice Address - Country:US
Practice Address - Phone:919-977-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)