Individual
CONNIE L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 EULON LOOP APT A, RAEFORD, NC 28376-9674
(910) 299-6226
Mailing address
1930 CLUB POND RD STE 107, RAEFORD, NC 28376-8691
(910) 299-6226
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
Primary
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/17/2021
Last updated
10/17/2021
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