Provider Demographics
NPI:1467591321
Name:SMITH, GEORGE TIMOTHY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:TIMOTHY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:610 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3202
Mailing Address - Country:US
Mailing Address - Phone:910-799-1071
Mailing Address - Fax:910-799-3313
Practice Address - Street 1:610 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3202
Practice Address - Country:US
Practice Address - Phone:910-799-1071
Practice Address - Fax:910-799-3313
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC898101YM0800X, 101YP2500X, 106H00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC198665OtherMEDCOST
NC198520OtherMEDCOST
NC6105105Medicaid