Provider Demographics
NPI:1578969143
Name:SMITH, PEACHES (BSW, MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:PEACHES
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSW, MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HIGHWOODS BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1027
Mailing Address - Country:US
Mailing Address - Phone:919-715-7400
Mailing Address - Fax:
Practice Address - Street 1:2900 KIDD RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1862
Practice Address - Country:US
Practice Address - Phone:919-532-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0018871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical