Provider Demographics
NPI:1699650457
Name:SMITH MOORE, LOLITA E (NCC, LCMHCA)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:E
Last Name:SMITH MOORE
Suffix:
Gender:F
Credentials:NCC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8307 SIX FORKS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3768
Mailing Address - Country:US
Mailing Address - Phone:919-605-0943
Mailing Address - Fax:
Practice Address - Street 1:8307 SIX FORKS RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3768
Practice Address - Country:US
Practice Address - Phone:919-605-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health