Provider Demographics
NPI:1992946388
Name:SMITH, JUDY C (LICSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 42
Mailing Address - Street 2:NUTMEG PLACE
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-9002
Mailing Address - Country:US
Mailing Address - Phone:304-888-0077
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 42
Practice Address - Street 2:NUTMEG PLACE
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-9002
Practice Address - Country:US
Practice Address - Phone:304-888-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009372771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical