Provider Demographics
NPI:1003471905
Name:SMITH, KATHERINE JOYCE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOYCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 SIX FORKS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5096
Mailing Address - Country:US
Mailing Address - Phone:919-890-5498
Mailing Address - Fax:
Practice Address - Street 1:8374 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5096
Practice Address - Country:US
Practice Address - Phone:919-890-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-18-33744103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst