Provider Demographics
NPI:1720228372
Name:SMITH PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:SMITH PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHIEF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PHD
Authorized Official - Phone:910-778-2427
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27281-0004
Mailing Address - Country:US
Mailing Address - Phone:910-778-2427
Mailing Address - Fax:
Practice Address - Street 1:1107 SEVEN LAKES DRIVE
Practice Address - Street 2:
Practice Address - City:SEVEN LAKES
Practice Address - State:NC
Practice Address - Zip Code:27376-0000
Practice Address - Country:US
Practice Address - Phone:910-778-2427
Practice Address - Fax:910-673-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3503103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52035OtherNATIONAL REGISTER OF HEALTH CARE PROVIDERS
NC6001053Medicaid
NC6001053Medicaid