Healthcare Provider Details

I. General information

NPI: 1245885052
Provider Name (Legal Business Name): KATRINA RHENEA SMITH-TOOLE ED.S/ M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E JACKSON ST
GATE CITY VA
24251-3526
US

IV. Provider business mailing address

340 E JACKSON ST
GATE CITY VA
24251-3526
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-7615
  • Fax:
Mailing address:
  • Phone: 276-386-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: