Provider Demographics
NPI:1407100373
Name:SMITH, JOEL CHISON (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:CHISON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 JAKES RUN RD
Mailing Address - Street 2:
Mailing Address - City:CORE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-7201
Mailing Address - Country:US
Mailing Address - Phone:304-276-9955
Mailing Address - Fax:
Practice Address - Street 1:855 JAKES RUN RD
Practice Address - Street 2:
Practice Address - City:CORE
Practice Address - State:WV
Practice Address - Zip Code:26541-7201
Practice Address - Country:US
Practice Address - Phone:304-276-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009424561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical