Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist | ||
N | 104100000X | Social Worker |
NPI | 1578887873 |
---|---|
Provider Name | Mr. Gary Lamont Smith |
First Address | Charlotte, NC 28206-2704 |
Second Address | Charlotte, NC 28206-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2010 |
Last Update Date | 02/11/2012 |