Provider Demographics
NPI:1255961637
Name:SMITH, TARA R (BSW, CDAC)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSW, CDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2317
Mailing Address - Country:US
Mailing Address - Phone:336-472-8230
Mailing Address - Fax:
Practice Address - Street 1:1301 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2317
Practice Address - Country:US
Practice Address - Phone:336-462-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)