Provider Demographics
NPI:1134959562
Name:SMITH, ANNA ROSE (LCSWA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EASY ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4190
Mailing Address - Country:US
Mailing Address - Phone:701-650-8800
Mailing Address - Fax:
Practice Address - Street 1:11 UNION ST S STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5098
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:704-270-6213
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0210711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical