Provider Demographics
NPI:1891062097
Name:SMITH, QUANDRA V
Entity Type:Individual
Prefix:
First Name:QUANDRA
Middle Name:V
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 S MEBANE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6590
Mailing Address - Country:US
Mailing Address - Phone:336-918-3057
Mailing Address - Fax:
Practice Address - Street 1:1708 S MEBANE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6590
Practice Address - Country:US
Practice Address - Phone:336-918-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional