Individual provider Active NPI

Lonnie W. Smith Jr., PHD, LPC, NCC

  • Mental Health Counselor
  • Winston Salem, NC
National Provider Identifier
1902126659
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
7599 Issued in NC
Practice address
1001 Reynolda Rd
Winston Salem, NC 27104-3245
Phone
(336) 721-7616
Fax
(336) 721-7676
NPI assigned
Jun 4, 2010
Last updated
May 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 7599 NC Primary

Addresses

Primary practice location

1001 Reynolda Rd
Winston Salem, NC 27104-3245

Mailing address

1001 Reynolda Rd
Winston Salem, NC 27104-3245
Phone (336) 721-7616

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241121002501 NC Practitioner - Mental Health Counselor 3971038340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7029 Albert Pick Rd
Suite 200
Greensboro, NC 27409-9521
Phone (919) 972-7700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
7599NCMDPublic Health Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, PC CurrentSince Jul 14, 2024 Accepting new patients
Optum Behavioral Care of North Carolina, PC Current Accepting new patients
Optum Behavioral Care of North Carolina, P.C. CurrentSince Jul 14, 2024 Accepting new patients

Locations

11000 Optum Cir
Eden Prairie, MN 55344
Phone (888) 445-8745

1101 Marco Dr
Ste 200
Apex, NC 27502
Phone (844) 534-7202

7029 Albert Pick Rd
Ste 200
Greensboro, NC 27409
Phone (704) 885-0268

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1902126659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-721-7616",
            "fax_number": "336-721-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-721-7616",
            "fax_number": "336-721-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LONNIE",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PHD, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-04",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.