Provider Demographics
NPI:1750542833
Name:LINDA ANNETTE SMITH, LCSW, PA
Entity type:Organization
Organization Name:LINDA ANNETTE SMITH, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-718-4937
Mailing Address - Street 1:138 S STEELE ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4201
Mailing Address - Country:US
Mailing Address - Phone:919-718-4937
Mailing Address - Fax:919-776-7433
Practice Address - Street 1:138 S STEELE ST
Practice Address - Street 2:SUITE N
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4201
Practice Address - Country:US
Practice Address - Phone:919-718-4937
Practice Address - Fax:919-776-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0014531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78007OtherBCBS
NC6106056Medicaid
NC6106056Medicaid