Provider Demographics
NPI:1306250667
Name:SMITH, JESSICA BLAIRE (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIRE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 SUMMER HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-3516
Mailing Address - Country:US
Mailing Address - Phone:828-231-6551
Mailing Address - Fax:
Practice Address - Street 1:204 CHARLOTTE HWY STE E
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8681
Practice Address - Country:US
Practice Address - Phone:828-333-5708
Practice Address - Fax:828-484-1025
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3572-A101YA0400X
NC9351101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health