Healthcare Provider Details

I. General information

NPI: 1689217499
Provider Name (Legal Business Name): RACHEL N SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MCLAWS CIR
WILLIAMSBURG VA
23185-5660
US

IV. Provider business mailing address

376 MERRIMAC TRL UNIT 613
WILLIAMSBURG VA
23185-4812
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0111
  • Fax:
Mailing address:
  • Phone: 757-234-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010491
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: