Matthew R Smith, LPCA, LCASA, NCC
Individual provider Active NPI Mental Health Counselor · Charlotte, NC
NPI 1114446002 · NPPES record last updated Nov 29, 2017
Key facts
- NPI
- 1114446002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- A13592 (NC)
- Practice address
- 1801 E 5TH St Ste 208
Charlotte, NC 28204-3400 - Phone
- (704) 954-8295
- NPI assigned
- Sep 12, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23855 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| A13592 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Era Counseling, PLLC | Addiction (Substance Use Disorder) | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 23855 | NC | |
| Mental Health Counselor | 101YM0800X | A13592 | NC | Yes |
Addresses
Primary practice location
1801 E 5TH St Ste 208
Charlotte, NC 28204-3400
Mailing address
325 Rehobeth Rd
Waxhaw, NC 28173-8641
Phone (704) 954-8295
Other providers in Charlotte, NC
- Mark David Smith
- Mark Edward Smith
- Martha Gibson Smith
- Mary Frances Smith
- Matthew Smith
- Megan Ashley Smith
- Megan E Smith
- Melanie Nicole Smith
- Melissa Robin Smith
- Merry Smith
All providers in Charlotte, NC · Mental Health Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.