Provider Demographics
NPI:1740614064
Name:IRWIN-SMILER, ANDREW PAUL (PHD, MA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:IRWIN-SMILER
Suffix:
Gender:M
Credentials:PHD, MA
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:PAUL
Other - Last Name:SMILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MA
Mailing Address - Street 1:2910 BRIARCLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-245-8161
Mailing Address - Fax:336-773-0332
Practice Address - Street 1:2910 BRIARCLIFF ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-245-8161
Practice Address - Fax:336-773-0332
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAPPLICANT103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist