Provider Demographics
NPI:1922451640
Name:SMITH, CHRISTAL (LCSA-A)
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSA-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERVIEW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3724
Mailing Address - Country:US
Mailing Address - Phone:336-907-7819
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERVIEW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3724
Practice Address - Country:US
Practice Address - Phone:336-907-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22911101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor