Individual
MRS. VIRGINIA A SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
520 58TH ST. STE 200, KENOSHA, WI 53140
(262) 748-6048
Mailing address
520 58TH ST STE 200, KENOSHA, WI 53140
(262) 748-6048
(262) 753-1922
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3146-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306114372
UNITED BEHAVIORAL HEALTH
WI
01
—
39662932002
BLUE CROSS/ BLUE SHIELD
WI
05
—
40932400
—
WI
01
—
861097264
HUMANA
WI
01
—
9356249
PHCS
WI
Enumeration date
07/17/2006
Last updated
05/11/2023
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