Healthcare Provider Details

I. General information

NPI: 1922235860
Provider Name (Legal Business Name): KATHIANNE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 3RD ST SW
ROANOKE VA
24016-5205
US

IV. Provider business mailing address

911 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5355
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-3577
  • Fax: 540-343-3866
Mailing address:
  • Phone: 434-984-0023
  • Fax: 434-984-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: