Provider Demographics
NPI:1306875612
Name:SMITH, PETER J (EDD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WESTGREEN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4417
Mailing Address - Country:US
Mailing Address - Phone:919-933-6500
Mailing Address - Fax:919-933-0334
Practice Address - Street 1:100 WESTGREEN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4417
Practice Address - Country:US
Practice Address - Phone:919-933-6500
Practice Address - Fax:919-933-0334
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2105103TA0700X, 103TB0200X, 103TC2200X, 103TF0000X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0407POtherBCBS OF NC
NC2816393AMedicare PIN