Provider Demographics
NPI:1922649888
Name:SMITH, ISAAC ANTHONY (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 VIOLA SIPE DR
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8839
Mailing Address - Country:US
Mailing Address - Phone:828-256-3436
Mailing Address - Fax:
Practice Address - Street 1:929 15TH ST NE STE 100
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4162
Practice Address - Country:US
Practice Address - Phone:828-256-3436
Practice Address - Fax:828-256-3623
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013718104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker