Provider Demographics
NPI:1962894535
Name:SMITH, ERIC (CASAC-2)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ELECTRIC DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-1933
Mailing Address - Country:US
Mailing Address - Phone:803-905-8470
Mailing Address - Fax:803-905-5171
Practice Address - Street 1:755 ELECTRIC DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-1933
Practice Address - Country:US
Practice Address - Phone:803-905-8470
Practice Address - Fax:803-905-5171
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26540101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)