Provider Demographics
NPI:1306419379
Name:SMITH, MORGAN L
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2537
Mailing Address - Country:US
Mailing Address - Phone:304-344-3403
Mailing Address - Fax:304-414-0157
Practice Address - Street 1:1420 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2537
Practice Address - Country:US
Practice Address - Phone:304-344-3403
Practice Address - Fax:304-414-0157
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator