Provider Demographics
NPI:1912425224
Name:SMITH, TAMMY AYSCUE (LMFTA, LPCA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:AYSCUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFTA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 LASHLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2200
Mailing Address - Country:US
Mailing Address - Phone:336-512-7792
Mailing Address - Fax:
Practice Address - Street 1:501 EASTOWNE DR STE 220
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6224
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health