Provider Demographics
NPI:1154896611
Name:SMITH, BRITTANY CRYSTAL
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:CRYSTAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 N DAVIDSON ST APT 121
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1193
Mailing Address - Country:US
Mailing Address - Phone:347-628-8307
Mailing Address - Fax:
Practice Address - Street 1:6300 LYNN CREST LN APT 106
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2873
Practice Address - Country:US
Practice Address - Phone:347-628-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14021101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor