Provider Demographics
NPI:1982738613
Name:GODFREY, EMILY SMITH (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SMITH
Last Name:GODFREY
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 1:280 CABIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-9503
Mailing Address - Country:US
Mailing Address - Phone:704-855-1704
Mailing Address - Fax:
Practice Address - Street 1:280 CABIN CREEK RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-9503
Practice Address - Country:US
Practice Address - Phone:704-855-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC004244OtherLCSW