Provider Demographics
NPI:1386715217
Name:SMELTZER, JILL MARTIN (LCSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARTIN
Last Name:SMELTZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1403
Mailing Address - Country:US
Mailing Address - Phone:276-356-5289
Mailing Address - Fax:276-628-9892
Practice Address - Street 1:389 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8093
Practice Address - Country:US
Practice Address - Phone:276-356-5289
Practice Address - Fax:276-628-9892
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186888OtherANTHEM
VA5165186OtherAETNA BEHAVIORAL HEALTH
VA00W995J01Medicare ID - Type Unspecified