Provider Demographics
NPI:1154183481
Name:SMITH, JENNIE REBECCA
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:REBECCA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 W BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1610
Mailing Address - Country:US
Mailing Address - Phone:304-359-2380
Mailing Address - Fax:
Practice Address - Street 1:285 W BIRCH LN
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1610
Practice Address - Country:US
Practice Address - Phone:304-359-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health