Provider Demographics
NPI:1235223116
Name:SMYTHE, KEVIN FRANCIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:SMYTHE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRIARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8089
Mailing Address - Country:US
Mailing Address - Phone:919-303-9984
Mailing Address - Fax:
Practice Address - Street 1:3801 LAKE BOONE TRL STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2969
Practice Address - Country:US
Practice Address - Phone:919-784-9182
Practice Address - Fax:919-784-9184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist