Provider Demographics
NPI:1639282676
Name:SMITH, KRISTY K (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 ALTA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3261
Mailing Address - Country:US
Mailing Address - Phone:919-386-0402
Mailing Address - Fax:919-882-0931
Practice Address - Street 1:110 PRESTON EXECUTIVE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8447
Practice Address - Country:US
Practice Address - Phone:919-386-0402
Practice Address - Fax:919-882-0931
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003637Medicaid