Provider Demographics
NPI:1124262159
Name:SMITH, ANNA F (MA, LPA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 COVIL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2684
Mailing Address - Country:US
Mailing Address - Phone:910-332-5734
Mailing Address - Fax:910-332-5739
Practice Address - Street 1:503 COVIL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2684
Practice Address - Country:US
Practice Address - Phone:910-332-5734
Practice Address - Fax:910-332-5739
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist