Provider Demographics
NPI:1063766525
Name:SMITH, ROSE MONIQUE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MONIQUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 SHINKANSEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5374
Mailing Address - Country:US
Mailing Address - Phone:203-394-3151
Mailing Address - Fax:
Practice Address - Street 1:8244 SHINKANSEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5374
Practice Address - Country:US
Practice Address - Phone:203-394-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0064641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical