Provider Demographics
NPI:1871183822
Name:SMITH, SHANEA LAUREN (LMFTA)
Entity Type:Individual
Prefix:
First Name:SHANEA
Middle Name:LAUREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 FOX COVE LN APT E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5967
Mailing Address - Country:US
Mailing Address - Phone:252-876-3056
Mailing Address - Fax:
Practice Address - Street 1:227 W MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3872
Practice Address - Country:US
Practice Address - Phone:336-908-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12249A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty