Individual
NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
RT. 10 THREE MILE CURVE, LOGAN, WV 25601-9998
(304) 792-7130
(304) 792-7146
Mailing address
PO BOX 176, LOGAN, WV 25601-0176
(304) 792-7130
(304) 792-7146
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
923
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005460000
—
WV
05
—
0005460001
—
WV
05
—
0005460002
—
WV
05
—
3810011604
—
WV
Enumeration date
01/11/2007
Last updated
07/01/2010
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