Healthcare Provider Details

I. General information

NPI: 1801837422
Provider Name (Legal Business Name): DAVID L SMOOT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 SIX FORKS RD SUITE 302
RALEIGH NC
27615-6561
US

IV. Provider business mailing address

6512 SIX FORKS RD SUITE 302
RALEIGH NC
27615-6561
US

V. Phone/Fax

Practice location:
  • Phone: 919-518-0390
  • Fax: 919-341-8210
Mailing address:
  • Phone: 919-518-0390
  • Fax: 919-341-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1617
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1617
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: