Vivian Devone Smith, MSW LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018568 Issued in NC

Practice address

128 E Broad St
Saint Pauls, NC 28384-1610

Phone

(910) 241-3042

Fax

(910) 241-3462

NPI assigned

Feb 13, 2008

Sex

Female

Sole proprietor

No

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)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renew Life Group, LLC

  • Community/Behavioral Health Agency
  • Laurinburg, NC
  • NPI 1003184789

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1801064860",
    "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": "128 E BROAD ST",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283841610",
            "telephone_number": "910-241-3042",
            "fax_number": "910-241-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "VIVIAN",
        "middle_name": "DEVONE",
        "name_prefix": "Ms.",
        "credential": "MSW LCASA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-13",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3314",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robeson Health Care Corporation
• Karis Rozier
• Dyanna Lynn Russell, B.S, CADC
• Ryan, James, Wiles, Patel & Olsen LLP
• Shinelight, Inc
• Southeastern Regional Medical Center
• Southeastern Regional Physician Services
• Southeastern Regional Physician Services
• Southeastern Regional Physician Services
• Spring Village Rest Home Inc

• Clinical Social Worker in Saint Pauls, NC
• Providers in Saint Pauls, 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 May 24, 2023; 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.