Provider Demographics
NPI:1366005902
Name:SMTIHBEY, MITCHELL DWIGHT
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DWIGHT
Last Name:SMTIHBEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 BALD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0316
Mailing Address - Country:US
Mailing Address - Phone:704-606-1018
Mailing Address - Fax:
Practice Address - Street 1:8122 BALD RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-0316
Practice Address - Country:US
Practice Address - Phone:704-606-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor