MEDICARE: SMITH PSYCHOLOGICAL SERVICES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist	3503	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52035	OTHER		NATIONAL REGISTER OF HEALTH CARE PROVIDERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720228372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH PSYCHOLOGICAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 4
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281-0004
Country	:	US
Telephone Number	:	910-778-2427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 SEVEN LAKES DRIVE
Second Line	:
City	:	SEVEN LAKES
State	:	NC
Zip	:	27376-0000
Country	:	US
Telephone Number	:	910-778-2427
Fax Number	:	910-673-5775

Authorized Official
Title or Position	:	DIRECTOR/CHIEF PSYCHOLOGIST
Name	:	DR. CAROL YVONNE SMITH
Credential	:	PHD, PHD
Telephone Number	:	910-778-2427

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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