Provider Demographics
NPI:1790905479
Name:SMITH, BARRY FOSTER (LPC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:FOSTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8556
Mailing Address - Country:US
Mailing Address - Phone:803-413-4756
Mailing Address - Fax:
Practice Address - Street 1:7511 SAINT ANDREWS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2806
Practice Address - Country:US
Practice Address - Phone:803-781-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional