Provider Demographics
NPI:1699853879
Name:SMITH, YVONNE DENISE (LCAS, CCS)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BRADFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301
Mailing Address - Country:US
Mailing Address - Phone:910-829-9017
Mailing Address - Fax:910-485-4752
Practice Address - Street 1:226 BRADFORD AVENUE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-829-9017
Practice Address - Fax:910-485-4752
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC764101YA0400X
NCLCAS-746;CCS-520101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111893Medicaid