Provider Demographics
NPI:1124827233
Name:SMITH, MALINDA (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 NASH ST N STE B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-3002
Mailing Address - Country:US
Mailing Address - Phone:252-514-5035
Mailing Address - Fax:252-376-1009
Practice Address - Street 1:3204 NASH ST N STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-3002
Practice Address - Country:US
Practice Address - Phone:252-319-5454
Practice Address - Fax:252-376-1009
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0203831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical