Healthcare Provider Details

I. General information

NPI: 1952274946
Provider Name (Legal Business Name): JOHNNA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 6TH AVE W
HUNTINGTON WV
25701-1716
US

IV. Provider business mailing address

695 MOUNTAINEER HWY
MULLENS WV
25882-0255
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-8014
  • Fax: 304-525-8026
Mailing address:
  • Phone: 304-294-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2843950
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: