Provider Demographics
NPI:1841657087
Name:SMIT-DILLARD, STEPHANIE MARY
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARY
Last Name:SMIT-DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:MARY
Other - Last Name:SMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1814 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1027
Practice Address - Country:US
Practice Address - Phone:347-891-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical