Healthcare Provider Details

I. General information

NPI: 1144206269
Provider Name (Legal Business Name): PAMELA PEARMAN SMITH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COBBLERIDGE CT
DURHAM NC
27713-9493
US

IV. Provider business mailing address

2 COBBLERIDGE CT
DURHAM NC
27713-9493
US

V. Phone/Fax

Practice location:
  • Phone: 919-612-0692
  • Fax: 919-212-7558
Mailing address:
  • Phone: 919-612-0692
  • Fax: 919-212-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1422
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: