Provider Demographics
NPI:1578452850
Name:SMITH, JASON D (MED, LCMHCA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 ED HERRING RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8332
Mailing Address - Country:US
Mailing Address - Phone:615-495-5679
Mailing Address - Fax:
Practice Address - Street 1:7151 OKELLY CHAPEL RD STE 181
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6849
Practice Address - Country:US
Practice Address - Phone:919-751-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20754101YM0800X
NC1242639101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool