Provider Demographics
NPI:1144721846
Name:SMITH JOHNSON, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SMITH JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 VANSTORY DR STE 109
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8146
Mailing Address - Country:US
Mailing Address - Phone:304-444-8735
Mailing Address - Fax:980-422-0240
Practice Address - Street 1:11330 VANSTORY DR STE 109
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8146
Practice Address - Country:US
Practice Address - Phone:304-444-8735
Practice Address - Fax:980-422-0240
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist