Provider Demographics
NPI:1275363467
Name:SMITH, AARON MILES (BS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MILES
Last Name:SMITH
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MARY ANN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2842
Mailing Address - Country:US
Mailing Address - Phone:585-967-6839
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4543
Practice Address - Country:US
Practice Address - Phone:980-237-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health