Provider Demographics
NPI:1104375088
Name:SMITH, LAURA ANN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5370
Mailing Address - Country:US
Mailing Address - Phone:304-242-7060
Mailing Address - Fax:
Practice Address - Street 1:2606 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5370
Practice Address - Country:US
Practice Address - Phone:304-242-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV294101YP2500X
PAPC012359101YP2500X
WV2285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV294OtherBOARD O EXAMINERS IN COUNSELING PROVISIONAL LICENSE