Provider Demographics
NPI:1255626578
Name:SMITH, LYDIA BOLDT (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:BOLDT
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:ANN
Other - Last Name:DRONGOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9201 UNIVERSITY CITY BLVD.
Mailing Address - Street 2:COUNSELING
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28223-0001
Mailing Address - Country:US
Mailing Address - Phone:704-687-6960
Mailing Address - Fax:
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD.
Practice Address - Street 2:COUNSELING
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC8546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional