Provider Demographics
NPI:1245885052
Name:SMITH-TOOLE, KATRINA RHENEA (EDS/ MED)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:RHENEA
Last Name:SMITH-TOOLE
Suffix:
Gender:F
Credentials:EDS/ MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3526
Mailing Address - Country:US
Mailing Address - Phone:276-386-7615
Mailing Address - Fax:
Practice Address - Street 1:340 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3526
Practice Address - Country:US
Practice Address - Phone:276-386-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000032103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool