Provider Demographics
NPI:1649489345
Name:SMITH, ELIZABETH FAWCETT (MT-BC)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:FAWCETT
Last Name:SMITH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 MILL HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7446
Mailing Address - Country:US
Mailing Address - Phone:919-475-0670
Mailing Address - Fax:
Practice Address - Street 1:4912 MILL HILL LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7446
Practice Address - Country:US
Practice Address - Phone:919-475-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
07116225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist