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General NPI Number Information
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NPI Number | 1194917211
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Entity Type | Individual
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Provider Name | KATHLEEN WILCOX SMITH MS, LPC, LADC, CRC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 91 S MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2509
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Country | US
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Telephone | 860-205-1066
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Fax | 860-521-8291
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Provider Business Mailing Address
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Address Line | 78 CLIFFMORE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1121
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Country | US
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Telephone | 860-205-1066
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Fax | 860-521-8291
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000302
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001086
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License Number State | CT
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