Provider Demographics
NPI:1386456077
Name:SMITH, RACHEL LEE (MA, MED)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:LEE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MED
Mailing Address - Street 1:8257 MOUNT CLARE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLARE
Mailing Address - State:WV
Mailing Address - Zip Code:26408-0349
Mailing Address - Country:US
Mailing Address - Phone:304-365-0859
Mailing Address - Fax:
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1767
Practice Address - Country:US
Practice Address - Phone:304-842-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVE6C141300070101YS0200X
WV907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool