Provider Demographics
NPI:1447568878
Name:SMITH, KATHRYN L (MA, LPA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 35TH ST STE B-2
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3183
Mailing Address - Country:US
Mailing Address - Phone:252-269-2160
Mailing Address - Fax:
Practice Address - Street 1:209 N 35TH ST STE B-2
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3183
Practice Address - Country:US
Practice Address - Phone:252-269-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1039103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist