Healthcare Provider Details

I. General information

NPI: 1396973822
Provider Name (Legal Business Name): MARY ELIZABETH SMITH LPC, ALPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 US ROUTE 60
HUNTINGTON WV
25705-2837
US

IV. Provider business mailing address

99 CRACKER BARREL DR STE 100
BARBOURSVILLE WV
25504-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax:
Mailing address:
  • Phone: 45-257-8513
  • Fax: 304-696-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1948
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: