Individual
LACECHAVE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4207 GARDEN ST, WINSTON SALEM, NC 27105-3239
(704) 756-0160
Mailing address
4207 GARDEN ST, WINSTON SALEM, NC 27105-3239
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
31632495
NC
344600000X
Taxi
31632495
NC
347E00000X
Transportation Broker
Primary
31632496
NC
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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