Provider Demographics
NPI:1598111866
Name:SMITH, PHYLLIS CHRISTINE (LMFTA)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:CHRISTINE
Other - Last Name:GAULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3332 BRIDGES ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3280
Mailing Address - Country:US
Mailing Address - Phone:888-557-1675
Mailing Address - Fax:888-557-1675
Practice Address - Street 1:3332 BRIDGES ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3280
Practice Address - Country:US
Practice Address - Phone:888-557-1675
Practice Address - Fax:888-557-1675
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11034A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist