Provider Demographics
NPI:1669806477
Name:SMITH, ALICE CHRISTINE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S HAWTHORNE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3913
Mailing Address - Country:US
Mailing Address - Phone:336-277-1881
Mailing Address - Fax:336-277-1899
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-277-1881
Practice Address - Fax:336-277-1899
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered