Provider Demographics
NPI:1457554065
Name:SMITH, ANDREA RENEE (NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 7 LKS W
Mailing Address - Street 2:119 DENNIS CIRCLE
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9306
Mailing Address - Country:US
Mailing Address - Phone:910-673-1377
Mailing Address - Fax:910-673-1377
Practice Address - Street 1:7900 TRIAD CENTER DR
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9073
Practice Address - Country:US
Practice Address - Phone:336-931-1823
Practice Address - Fax:336-931-1801
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300970Medicaid
NC8301314Medicare ID - Type UnspecifiedPROVIDER NUMBER
NC8300970Medicaid