Provider Demographics
NPI:1649312992
Name:SMITH, ANITA MICHELE (MED, EDS, LPC)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, EDS, LPC
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:MICHELE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED/ EDS, LPC
Mailing Address - Street 1:2040 CAMPUS BOX
Mailing Address - Street 2:ELON UNIVERISTY
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 CAMPUS BOX
Practice Address - Street 2:ELON UNIVERSITY
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27244
Practice Address - Country:US
Practice Address - Phone:336-278-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5458101YM0800X
SC5102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health