Provider Demographics
NPI:1104308287
Name:SMITH, CASSIEL SUNDIATA STERLING (LPCA, LCASA)
Entity type:Individual
Prefix:MR
First Name:CASSIEL
Middle Name:SUNDIATA STERLING
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COPPERFIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2428
Mailing Address - Country:US
Mailing Address - Phone:704-782-3131
Mailing Address - Fax:704-782-3133
Practice Address - Street 1:300 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2428
Practice Address - Country:US
Practice Address - Phone:704-782-3131
Practice Address - Fax:704-782-3133
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14187101YP2500X
NC24205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional