Healthcare Provider Details

I. General information

NPI: 1811263312
Provider Name (Legal Business Name): JULIANN SMITH PHD., LPC, NCC, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

IV. Provider business mailing address

311 S MONROE AVE THE GUINAN CENTER
COVINGTON VA
24426-1635
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-2100
  • Fax: 540-965-2105
Mailing address:
  • Phone: 540-965-2100
  • Fax: 540-965-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003272
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number44886
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number06155
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: