Provider Demographics
NPI:1093313116
Name:SMITH, COTINA NICOLE (LCASA)
Entity type:Individual
Prefix:
First Name:COTINA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:COTINA
Other - Middle Name:NICOLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 UNITED ST APT 302
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6663
Mailing Address - Country:US
Mailing Address - Phone:919-520-8417
Mailing Address - Fax:
Practice Address - Street 1:31 UNITED ST APT 302
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6663
Practice Address - Country:US
Practice Address - Phone:919-520-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26554101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty