Provider Demographics
NPI:1265484661
Name:SMITH, HAMLET DON II (LICSW)
Entity Type:Individual
Prefix:
First Name:HAMLET
Middle Name:DON
Last Name:SMITH
Suffix:II
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HARPER CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2650
Mailing Address - Country:US
Mailing Address - Phone:304-255-7526
Mailing Address - Fax:
Practice Address - Street 1:120 HARPER CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2650
Practice Address - Country:US
Practice Address - Phone:304-255-7526
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009399811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP03501Medicare ID - Type Unspecified