Provider Demographics
NPI:1750027637
Name:KING-SMITH, SINA (LPC, RDN)
Entity type:Individual
Prefix:
First Name:SINA
Middle Name:
Last Name:KING-SMITH
Suffix:
Gender:F
Credentials:LPC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 MERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2317
Mailing Address - Country:US
Mailing Address - Phone:304-685-1524
Mailing Address - Fax:
Practice Address - Street 1:709 BEECHURST AVE STE 14B
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4689
Practice Address - Country:US
Practice Address - Phone:724-249-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86033141133V00000X
WV3064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered