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General NPI Number Information
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NPI Number | 1396518387
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Entity Type | Organization
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Legal Business Name | PSYCH WISE LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 124 BEVERLY AVE. SW
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 276-870-0917
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Fax |
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Provider Business Mailing Address
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Address Line | 124 BEVERLY AVE. SW
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 276-870-0917
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MS. DORA LEE SMITH
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Credential | LPC
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Telephone | 276-870-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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