Carol Yvonne Smith, PHD, PHD, MS, LICSW,
Individual provider Active NPI Clinical Psychologist · Seven Lakes, NC
NPI 1326044546 · NPPES record last updated Mar 30, 2009
Key facts
- NPI
- 1326044546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 3503 (NC)
- Practice address
- 1107 Seven Lakes Drive
Seven Lakes, NC 27376-0000 - Phone
- (910) 778-2427
- Fax
- (910) 673-5775
- NPI assigned
- Jun 22, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12946 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 4272-123 | WI | MD | Clinical Social Worker |
| 3503 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Integrative Behavioral Medicine, PC | Clinical | Past | Accepting new patients |
| Achievement Associates, LTD | Clinical | Past | Accepting new patients |
| C.Y. Smith & Associates, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12946 | WI | |
| Clinical Psychologist | 103TC0700X | 3503 | NC | Yes |
| Clinical Social Worker | 1041C0700X | 4272-123 | WI |
Addresses
Primary practice location
1107 Seven Lakes Drive
Seven Lakes, NC 27376-0000
Mailing address
PO Box 4
Jackson Springs, NC 27281-0004
Phone (414) 975-9908
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6001053 | Medicaid | NC | |
| 39530500 | Medicaid | WI |
Other providers in Seven Lakes, NC
- Jennifer Stallings Massey
- Quality Care Pharmacy of the Sandhills, Inc
- Susan Rospert
- Seven Lakes Emergency Medical Service, Inc.
- Smith Psychological Services, P.C.
- Katelynne Marie Adams Svalina
- Sweet Magnolia Speech Therapy PLLC
- Carmen Thomas
- Wake Integrative Behavioral Medicine, PC
All providers in Seven Lakes, NC · Clinical Psychologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.