Provider Demographics
NPI:1104267624
Name:SMYRE, JANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:SMYRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:SMYRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:320 WINDY ACRES RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28626-9693
Mailing Address - Country:US
Mailing Address - Phone:133-687-7613
Mailing Address - Fax:
Practice Address - Street 1:101 E BUCK MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-7374
Practice Address - Country:US
Practice Address - Phone:336-877-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCP0073321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104267624Medicaid