Provider Demographics
NPI:1952080640
Name:SMITH, KIRSTEN TANYE (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:TANYE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:TANYE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:501 PALADIN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7826
Mailing Address - Country:US
Mailing Address - Phone:252-353-5346
Mailing Address - Fax:
Practice Address - Street 1:501 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-353-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0193521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical