Provider Demographics
NPI:1144950205
Name:SMITH, DAVID L JR (CPCT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:CPCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-7161
Mailing Address - Country:US
Mailing Address - Phone:304-830-1277
Mailing Address - Fax:
Practice Address - Street 1:92 N 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1600
Practice Address - Country:US
Practice Address - Phone:304-830-1277
Practice Address - Fax:740-633-4141
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator