Provider Demographics
NPI:1174352264
Name:SMITH, SHELBY NICOLE (NCC, LPC-A)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ALWYN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4091
Mailing Address - Country:US
Mailing Address - Phone:706-832-2707
Mailing Address - Fax:
Practice Address - Street 1:105 CENTRAL AVE UNIT 17
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3278
Practice Address - Country:US
Practice Address - Phone:843-974-3739
Practice Address - Fax:843-402-8559
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty