Provider Demographics
NPI:1902176613
Name:SMITH, TAMARA NICOLE (MS, CRC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 JOHN BROWN RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5708
Mailing Address - Country:US
Mailing Address - Phone:336-451-3779
Mailing Address - Fax:
Practice Address - Street 1:201 JOHN BROWN RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5708
Practice Address - Country:US
Practice Address - Phone:336-451-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health