Provider Demographics
NPI:1952490039
Name:SMART, CHERYL ANN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:SMART
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0001
Mailing Address - Country:US
Mailing Address - Phone:864-888-4211
Mailing Address - Fax:888-671-7027
Practice Address - Street 1:206 W NORTH 1ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3250
Practice Address - Country:US
Practice Address - Phone:864-888-4211
Practice Address - Fax:888-671-7027
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC72831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ352380281OtherMEDICARE PTAN