Provider Demographics
NPI:1063117224
Name:SMITH, CHARAY SHARONDA (LCAS-A / EDD/ MSA)
Entity type:Individual
Prefix:DR
First Name:CHARAY
Middle Name:SHARONDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCAS-A / EDD/ MSA
Other - Prefix:DR
Other - First Name:CHARAY
Other - Middle Name:SHARONDA
Other - Last Name:DUPREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1537 STACKHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6356
Mailing Address - Country:US
Mailing Address - Phone:910-835-7006
Mailing Address - Fax:
Practice Address - Street 1:1537 STACKHOUSE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6356
Practice Address - Country:US
Practice Address - Phone:910-835-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 101Y00000X
NC101YS0200X
NCLCAS29000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor