Provider Demographics
NPI:1841008893
Name:SMITH, WESTON JAMES (NC CPSS)
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:NC CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 BRIXHAM HILL AVE STE 475
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0878
Mailing Address - Country:US
Mailing Address - Phone:704-251-9084
Mailing Address - Fax:
Practice Address - Street 1:15801 BRIXHAM HILL AVE STE 475
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0878
Practice Address - Country:US
Practice Address - Phone:704-251-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCM2024-12859-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist