James Donta Smith

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P021403 Issued in NC

Practice address

307 E Wardell Dr
Pembroke, NC 28372-7998

Phone

(910) 521-2816

Fax

(910) 521-3583

NPI assigned

Jan 2, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1346953726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLAZA CIR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727386",
            "telephone_number": "910-521-2900",
            "fax_number": "910-775-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E WARDELL DR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727998",
            "telephone_number": "910-521-2816",
            "fax_number": "910-521-3583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Martin Luther King Jr Dr",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283586937",
            "country_code": "US",
            "telephone_number": "910-370-0815",
            "fax_number": "910-674-3083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JAMES",
        "middle_name": "DONTA",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-02",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-30329",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P021403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lilly Marie Shorter, LCAS 21705
• Asjah Simpson
• Heather Smiling, LPCA
• Denene P. Smith, FNP
• Donnesha Smith
• Lavirsa Smith
• Megan Elizabeth Smith
• Southeastern Integrated Care
• Southeastern Regional Medical Center (Southeastern Urgent Care Pembroke)
• Southeastern Regional Physician Services (Southeastern Urgent Care Pembroke)

• Clinical Social Worker in Pembroke, NC
• Providers in Pembroke, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.