Provider Demographics
NPI:1689071490
Name:SMITH, JAMISE ROSCHELLE (BSW, CSAC)
Entity Type:Individual
Prefix:MS
First Name:JAMISE
Middle Name:ROSCHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7925 N TRYON ST
Mailing Address - Street 2:STE 207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3408
Mailing Address - Country:US
Mailing Address - Phone:704-612-0566
Mailing Address - Fax:704-498-4846
Practice Address - Street 1:7925 N TRYON ST
Practice Address - Street 2:STE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3408
Practice Address - Country:US
Practice Address - Phone:704-612-0566
Practice Address - Fax:704-498-4846
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)