MEDICARE: MICHELLE K SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2361	WV

General Provider Information

NPI Number	:	1285101758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE K SMITH

Provider Business Mailing Address
First Line	:	5205 RAVEN DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25306-6244
Country	:	US
Telephone Number	:	304-610-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 GREENBRIER ST RM 160
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1007
Country	:	US
Telephone Number	:	304-700-7876
Fax Number	:	681-265-5122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	06/11/2026

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Directions to “ MICHELLE K SMITH ” Practice Location

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