Provider Demographics
NPI:1295172831
Name:SMITH, WHITNEY BLACKWELL (LPC)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:BLACKWELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-7847
Mailing Address - Country:US
Mailing Address - Phone:336-777-3615
Mailing Address - Fax:
Practice Address - Street 1:3615 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-7847
Practice Address - Country:US
Practice Address - Phone:336-777-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133303101YP2500X
VA0701005464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417509985OtherNPI