Provider Demographics
NPI:1831179720
Name:SMITH, LINDA ANNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-1902
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0014531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78007OtherBLUE CROSS BLUE SHIELD
NC6106056Medicaid
NC78007OtherBLUE CROSS BLUE SHIELD