MEDICARE: JAMI LOU SMITHSON MA

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	101YP2500X	Professional Counselor	0704012505	VA

General Provider Information

NPI Number	:	1518626753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI LOU SMITHSON MA

Provider Business Mailing Address
First Line	:	9762 W RIVER RD
Second Line	:
City	:	AYLETT
State	:	VA
Zip	:	23009-2731
Country	:	US
Telephone Number	:	804-380-4652
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2628
Country	:	US
Telephone Number	:	804-322-9955
Fax Number	:	804-270-1088

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

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	12/15/2021

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