Individual
TRACY LYNN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4407 MACCORKLE AVE SE, CHARLESTON, WV 25304-2541
(304) 925-0800
(304) 925-0805
Mailing address
4407 MACCORKLE AVE SE, CHARLESTON, WV 25304-2541
(304) 925-0800
(304) 905-0805
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
785
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9205040000
—
WV
Enumeration date
08/30/2006
Last updated
08/13/2020
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