Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 2105 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2105 | NC |
Y | 103G00000X | Clinical Psychologist | 2105 | NC |
Y | 103TC0700X | Clinical Psychologist | 2105 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2105 | NC |
N | 103TF0000X | Family Psychologist | 2105 | NC |
N | 103TH0100X | Health Service | 2105 | NC |
NPI | 1306875612 |
---|---|
Provider Name | Dr. Peter J. Smith |
First Address | Chapel Hill, NC 27516-4417 |
Second Address | Chapel Hill, NC 27516-4417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 17/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0407P | BCBS OF NC (01) | NC |