| Psych Wise Llc | |
|
124 Beverly Ave. Sw Wise VA 24293 | |
| (276) 870-0917 | |
| Not Available |
| Full Name | Psych Wise Llc |
|---|---|
| Speciality | Counselor |
| Location | 124 Beverly Ave. Sw, Wise, Virginia |
| Authorized Official Name and Position | Dora Lee Smith (OWNER/COUNSELOR) |
| Authorized Official Contact | 2768700917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Wise Llc 124 Beverly Ave. Sw Wise VA 24293 Ph: (276) 870-0917 | Psych Wise Llc 124 Beverly Ave. Sw Wise VA 24293 Ph: (276) 870-0917 |
| NPI Number | 1396518387 |
|---|---|
| Provider Enumeration Date | 11/01/2023 |
| Last Update Date | 11/01/2023 |
| Certification Date | 11/01/2023 |
| Medicare PECOS PAC ID | 7517308083 |
|---|---|
| Medicare Enrollment ID | O20240515001129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396518387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Dora Lee Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225623598 PECOS PAC ID: 5799126264 Enrollment ID: I20240515001239 |
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