Organization
LAKE COUNTRY COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TESSIE S SMITH LCSW (LIC CLINICAL SOCIAL WORKER)
(434) 774-7559
Entity
Organization
Contact information
Practice address
516 W ATLANTIC ST, SOUTH HILL, VA 23970-1906
(434) 774-7559
(434) 447-3579
Mailing address
516 W ATLANTIC ST, SOUTH HILL, VA 23970-1906
(434) 774-7559
(434) 447-3579
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006071
VA
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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