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General NPI Number Information
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NPI Number | 1174274401
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Entity Type | Individual
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Provider Name | CHARLES SMITH LPC
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Gender | Male
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 12 N BRADDOCK ST
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City | WINCHESTER
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State | VA
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Zip | 22601-4120
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Country | US
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Telephone | 540-686-6909
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Fax | 540-242-3385
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Provider Business Mailing Address
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Address Line | 12 N BRADDOCK ST
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City | WINCHESTER
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State | VA
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Zip | 22601-4120
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Country | US
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Telephone | 540-686-6910
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Fax | 540-242-3385
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701011137
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License Number State | VA
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