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General NPI Number Information
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NPI Number | 1114221207
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Entity Type | Individual
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Provider Name | DAVID WAYNE SMITH LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 107 ROGER DR
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City | COLLINSVILLE
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State | IL
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Zip | 62234-5814
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Country | US
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Telephone | 618-792-1482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2008035911
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.004794
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License Number State | IL
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