Kelly Lachelle Smith, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PO11783 Issued in NC

Practice address

3117 Whiting Ave
Charlotte, NC 28205-1648

Phone

(980) 243-5595

NPI assigned

Nov 5, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• A Place 4 Me, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Charlotte, NC
  • NPI 1306455126

  Clinical

  Medicare reassignment NPD Authorized official
• A Place 4 Me, LLC

  • Community/Behavioral Health Agency
  • Concord, NC
  • NPI 1306630603

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1831490903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7410 NICCOLINE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282148079",
            "telephone_number": "562-743-8166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 WHITING AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051648",
            "telephone_number": "980-243-5595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7410 Niccoline Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282148079",
            "country_code": "US",
            "telephone_number": "562-743-5595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "LACHELLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-05",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "PO11783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P011783",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "myplaceishere.org",
            "affiliation": "N",
            "address_1": "5305 Clearwater Lake Rd",
            "city": "Mount Holly",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281201445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katherine Margaret Smith
• Kathy Smith
• Kathy A. Smith, CRNA
• Kaylah Smith, BCBA
• Kaylee Elizabeth Smith, MD
• Kendall Lamar Smith, DNP, CRNA
• Kendyl Smith
• Kevin Lindsay Smith, MD
• Kevin Scott Smith, M.D.
• Kimberly Smith

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, 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 Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.