Provider Demographics
NPI:1851942999
Name:SMITH, JOSHUA CHARLES
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHARLES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 BRIDFORD LAKE CIR APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5173
Mailing Address - Country:US
Mailing Address - Phone:864-992-0741
Mailing Address - Fax:
Practice Address - Street 1:7 OAK BRANCH DR STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2392
Practice Address - Country:US
Practice Address - Phone:864-992-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0139571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty