Provider Demographics
NPI:1437861903
Name:SMITH, CHUCK ANTHONY
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WACO DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8327
Mailing Address - Country:US
Mailing Address - Phone:606-770-5161
Mailing Address - Fax:606-770-5168
Practice Address - Street 1:43 WACO DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8327
Practice Address - Country:US
Practice Address - Phone:606-770-5161
Practice Address - Fax:606-770-5168
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health