Provider Demographics
NPI:1326173766
Name:COTTRILL-SMITH, DENICE J (MSW, LICSW, CAC)
Entity Type:Individual
Prefix:MS
First Name:DENICE
Middle Name:J
Last Name:COTTRILL-SMITH
Suffix:
Gender:F
Credentials:MSW, LICSW, CAC
Other - Prefix:
Other - First Name:DENICE
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW, CAC
Mailing Address - Street 1:4700 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3112
Mailing Address - Country:US
Mailing Address - Phone:304-295-7100
Mailing Address - Fax:
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:304-485-6710
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01-102101YA0400X
WVDP000801771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDP00080177OtherLICSW
WV01-102OtherCAC
WVCOSW27201Medicare ID - Type Unspecified7TH STREET MEDICARE