Basic Information
Provider Information | |||||||||
NPI: | 1346618188 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SMITH | ||||||||
FirstName: | LINDSAY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 207 FAIRMONT AVE | ||||||||
Address2: |   | ||||||||
City: | FAIRMONT | ||||||||
State: | WV | ||||||||
PostalCode: | 265542710 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6814046869 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 930 CHESTNUT RIDGE RD | ||||||||
Address2: |   | ||||||||
City: | MORGANTOWN | ||||||||
State: | WV | ||||||||
PostalCode: | 265052807 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042935323 | ||||||||
FaxNumber: | 3042857126 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/10/2015 | ||||||||
LastUpdateDate: | 01/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | BP00944082 | WV | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | DP00944082 | WV | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.