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General NPI Number Information
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NPI Number | 1336479740
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Entity Type | Individual
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Provider Name | COLLEEN D SMITH MA, LP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1 PRESTERA WAY
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City | HUNTINGTON
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State | WV
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Zip | 25705-2069
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Country | US
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Telephone | 304-525-7851
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Fax | 304-525-1073
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Provider Business Mailing Address
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Address Line | 5600 US ROUTE 60
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City | HUNTINGTON
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State | WV
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Zip | 25705-2146
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Country | US
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Telephone | 304-525-7851
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Fax | 304-525-1073
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 853
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License Number State | WV
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