Healthcare Provider Details

I. General information

NPI: 1548940570
Provider Name (Legal Business Name): COURTNEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

IV. Provider business mailing address

636 4 H CAMP RD
FAYETTEVILLE WV
25840-5915
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-3045
  • Fax:
Mailing address:
  • Phone: 304-575-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: