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Individual

BRYAN DOREKO PAUL SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
QP, ITFS, MHFA

Contact information

Practice address
1100 LOGGER CT STE E102, RALEIGH, NC 27609-8510
(919) 900-7200
(919) 900-7201
Mailing address
2924 TRASSACKS DR, RALEIGH, NC 27610-5497
(919) 900-7200
(919) 900-7201

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
174H00000X
Health Educator
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
374700000X
Technician
3747A0650X
Attendant Care Provider
3747P1801X
Personal Care Attendant
374U00000X
Home Health Aide

Other

Enumeration date
10/31/2022
Last updated
01/04/2023
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