Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1426 | NC |
NPI | 1518976430 |
---|---|
Provider Name | Connie Smith Philbeck |
First Address | Kannapolis, NC 28083-6232 |
Second Address | Albemarle, NC 28001-2833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6107204 | (05) | NC |