Provider Demographics
NPI:1649623166
Name:MABE-SMITH, TOBIE
Entity type:Individual
Prefix:
First Name:TOBIE
Middle Name:
Last Name:MABE-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ROBIN REED CT
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8852
Mailing Address - Country:US
Mailing Address - Phone:336-209-5022
Mailing Address - Fax:
Practice Address - Street 1:520 E HEBRON ST STE A-5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5989
Practice Address - Country:US
Practice Address - Phone:336-209-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional