Individual
EDWARD SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3609 MEMORY LN, RALEIGH, NC 27604-4127
(919) 622-0373
Mailing address
3609 MEMORY LN, RALEIGH, NC 27604-4127
(919) 622-0373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22554-A
NC
1041C0700X
Clinical Social Worker
Primary
P011177
NC
Other
Enumeration date
11/15/2013
Last updated
03/09/2017
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