Healthcare Provider Details

I. General information

NPI: 1427526011
Provider Name (Legal Business Name): BRANDY SMITH QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 WILLIAMSTOWN PIKE
WILLIAMSTOWN WV
26187-8168
US

IV. Provider business mailing address

1307 WILLIAMSTOWN PIKE
WILLIAMSTOWN WV
26187-8168
US

V. Phone/Fax

Practice location:
  • Phone: 304-834-4619
  • Fax:
Mailing address:
  • Phone: 304-834-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: