Individual
MRS. COLLEEN EWING SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 DOUGLAS AVE NW, ROANOKE, VA 24012-4611
(540) 852-2502
Mailing address
40 DOUGLAS AVE NW, ROANOKE, VA 24012-4611
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0803000302
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0813000761
—
VA
Enumeration date
02/27/2018
Last updated
12/06/2024
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