Provider Demographics
NPI:1790930170
Name:SMITH, DARRYL FREDERICK (PHD)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:FREDERICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1920
Mailing Address - Country:US
Mailing Address - Phone:919-402-4300
Mailing Address - Fax:919-402-4330
Practice Address - Street 1:111 CLOISTER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2295
Practice Address - Country:US
Practice Address - Phone:919-402-4300
Practice Address - Fax:919-402-4330
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000349Medicaid
NC2819781Medicare PIN