Individual
MITCHELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4700 9TH AVE, VIENNA, WV 26105-3112
(304) 555-5555
Mailing address
4700 9TH AVE, VIENNA, WV 26105-3112
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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