Provider Demographics
NPI:1952655144
Name:SMITH, PHILLIP COLBY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:COLBY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6921 SPRINGCREEK CV APT 22
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3255
Mailing Address - Country:US
Mailing Address - Phone:803-629-5231
Mailing Address - Fax:
Practice Address - Street 1:6921 SPRINGCREEK CV APT 22
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613
Practice Address - Country:US
Practice Address - Phone:803-629-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMFT-1611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist