Provider Demographics
NPI:1891226783
Name:SMITH, ADRIENNE MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W NC HIGHWAY 54
Mailing Address - Street 2:STE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 W NC HIGHWAY 54
Practice Address - Street 2:STE 121
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5577
Practice Address - Country:US
Practice Address - Phone:919-401-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1224A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist