Provider Demographics
NPI:1013508290
Name:SMOTHERS, TRIA (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:TRIA
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DAVELYN CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6048
Mailing Address - Country:US
Mailing Address - Phone:443-527-8675
Mailing Address - Fax:
Practice Address - Street 1:5401 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4462
Practice Address - Country:US
Practice Address - Phone:919-886-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health