Provider Demographics
NPI:1154723013
Name:SMITH, HOLLY (LPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3121
Mailing Address - Country:US
Mailing Address - Phone:540-315-0357
Mailing Address - Fax:540-602-3024
Practice Address - Street 1:90 COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2982
Practice Address - Country:US
Practice Address - Phone:540-602-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional