Provider Demographics
NPI:1700548880
Name:SMARSH, STEPHANIE A (RBT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SMARSH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DINA DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8668
Mailing Address - Country:US
Mailing Address - Phone:808-445-8250
Mailing Address - Fax:
Practice Address - Street 1:2815 CAROLINA COMMERCE DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5556
Practice Address - Country:US
Practice Address - Phone:919-810-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-21-187014106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician