Provider Demographics
NPI:1457634651
Name:SMITH, ANITA (MAC, LAC, DIPAC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAC, LAC, DIPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BOBBYS WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4461
Mailing Address - Country:US
Mailing Address - Phone:540-255-5050
Mailing Address - Fax:
Practice Address - Street 1:20 BOBBYS WAY STE 108
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4461
Practice Address - Country:US
Practice Address - Phone:540-255-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000618171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist