Provider Demographics
NPI:1619056504
Name:SMITH, ROSALYN J (LPC)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:YOUTH FOCUS
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2957
Mailing Address - Country:US
Mailing Address - Phone:336-333-6853
Mailing Address - Fax:
Practice Address - Street 1:315 E WASHINGTON ST
Practice Address - Street 2:FAMILY SERVICE OF THE PIEDMONT
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2911
Practice Address - Country:US
Practice Address - Phone:336-387-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103338Medicaid