Provider Demographics
NPI:1598417479
Name:SMOKOWSKI, PAUL (PHD, LCSWA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SMOKOWSKI
Suffix:
Gender:M
Credentials:PHD, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 TWEETSIE LN W
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-6612
Mailing Address - Country:US
Mailing Address - Phone:919-428-5716
Mailing Address - Fax:
Practice Address - Street 1:800 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4832
Practice Address - Country:US
Practice Address - Phone:919-428-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 222Q00000X
NCP0149171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist