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DR. CAROL YVONNE SMITH PHD, PHD, MS, LICSW,

Addiction Substance Use Disorder

Seven Lakes, North Carolina

Provider NPI: 1326044546

Provider Information:
DR. CAROL YVONNE SMITH PHD, PHD, MS, LICSW,
Gender: F
Not Sole Proprietor

Practice Location:
1107 SEVEN LAKES DRIVE  SEVEN LAKES, NC 27376 US
Tel: 910-778-2427  Fax: 910-673-5775

Business Mailing Address:
PO BOX 4  JACKSON SPRINGS, NC 27281 US
Tel: 414-975-9908  Fax: 910-673-5775

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
WI12946
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
NC3503
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
WI4272-123

Other Provider Identifiers:

IssuerNumberStateType
39530500WI05
6001053NC05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS NC - Page 1

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