Provider Demographics
NPI:1811778244
Name:SMITH, ZACHARIAH CHRISTIAN
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:CHRISTIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 GILROY DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5531
Mailing Address - Country:US
Mailing Address - Phone:704-918-2779
Mailing Address - Fax:
Practice Address - Street 1:3212 GILROY DR
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-5531
Practice Address - Country:US
Practice Address - Phone:704-918-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician