Provider Demographics
NPI:1366673030
Name:SMITH, CAROL COUNCIL (LPA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:COUNCIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STONERIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5578
Mailing Address - Country:US
Mailing Address - Phone:919-489-8607
Mailing Address - Fax:
Practice Address - Street 1:50 STONERIDGE RD.
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5578
Practice Address - Country:US
Practice Address - Phone:919-489-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1581103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11111OtherNO MEDICAID NUMBER