Individual
MRS. VICKI LOU WISE-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 PEGASUS CT STE 500, WINCHESTER, VA 22602-4596
(540) 313-4196
(540) 686-7906
Mailing address
716 W 13TH ST, FRONT ROYAL, VA 22630-2912
(540) 535-6196
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710103350
VA
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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