Provider Demographics
NPI:1699944306
Name:MONTGOMERY, KARAN SMITH (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KARAN
Middle Name:SMITH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S. HAWTHORNE ROAD
Mailing Address - Street 2:SUITE 622 NOVANT HEALTH
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3013
Mailing Address - Country:US
Mailing Address - Phone:336-760-4583
Mailing Address - Fax:336-760-8730
Practice Address - Street 1:1900 S. HAWTHORNE ROAD
Practice Address - Street 2:SUITE 622 NOVANT HEALTH
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-760-4583
Practice Address - Fax:336-760-8730
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 836101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor