Provider Demographics
NPI:1285277970
Name:SMITH, JEFFREY SCOTT (LCMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 ELM ST STE 209
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4164
Mailing Address - Country:US
Mailing Address - Phone:910-339-1572
Mailing Address - Fax:910-294-4989
Practice Address - Street 1:823 ELM ST STE 209
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4164
Practice Address - Country:US
Practice Address - Phone:910-339-1572
Practice Address - Fax:910-294-4989
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC14934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health