Organization
WAKE INTEGRATIVE BEHAVIORAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL YVONNE SMITH PHD, PHD, HSP (CEO/PRESIDENT/OWNER)
(414) 847-9351
Entity
Organization
Contact information
Practice address
1107 SEVEN LAKES DRIVE, SEVEN LAKES, NC 27376
(414) 847-9351
(888) 227-7795
Mailing address
80 BLAKE BLVD UNIT 3038, PINEHURST, NC 28374-9599
(414) 847-9351
(888) 822-7227
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3503
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3503
MY LICENSE
NC
Enumeration date
09/11/2017
Last updated
06/16/2018
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