Individual
DR. CAROL YVONNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, PHD, MS, LICSW,
Contact information
Practice address
1107 SEVEN LAKES DRIVE, SEVEN LAKES, NC 27376-0000
(910) 778-2427
(910) 673-5775
Mailing address
PO BOX 4, JACKSON SPRINGS, NC 27281-0004
(414) 975-9908
(910) 673-5775
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12946
WI
103TC0700X
Clinical Psychologist
Primary
3503
NC
1041C0700X
Clinical Social Worker
4272-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39530500
—
WI
05
—
6001053
—
NC
Enumeration date
06/22/2005
Last updated
03/30/2009
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