Provider Demographics
NPI:1750699559
Name:SMITH, VIRGINIA (LPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4269
Mailing Address - Country:US
Mailing Address - Phone:919-303-0273
Mailing Address - Fax:919-303-5986
Practice Address - Street 1:1091 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4269
Practice Address - Country:US
Practice Address - Phone:919-303-0273
Practice Address - Fax:919-303-5986
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional