Individual
LARRY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-4888
(843) 347-3959
Mailing address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-4888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2413A
NC
101YM0800X
Mental Health Counselor
2413A
NC
Other
Enumeration date
12/06/2012
Last updated
03/17/2018
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