Provider Demographics
NPI:1932743739
Name:SMITH, SHAMUS OLIVER (LCAS)
Entity Type:Individual
Prefix:MR
First Name:SHAMUS
Middle Name:OLIVER
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ASHE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-8613
Mailing Address - Country:US
Mailing Address - Phone:561-809-7801
Mailing Address - Fax:
Practice Address - Street 1:356 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2916
Practice Address - Country:US
Practice Address - Phone:828-287-7945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)