Provider Demographics
NPI:1316133887
Name:SIMPSON-SMITH, SHIRENA (LCSW)
Entity type:Individual
Prefix:
First Name:SHIRENA
Middle Name:
Last Name:SIMPSON-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 W WENDOVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1525
Mailing Address - Country:US
Mailing Address - Phone:336-294-1349
Mailing Address - Fax:336-292-6711
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-451-1113
Practice Address - Fax:336-292-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106778Medicaid
NC6106778Medicaid