Timothy Smith, LPC
Individual provider Active NPI Professional Counselor · Pembroke, VA
NPI 1659059384 · NPPES record last updated Mar 11, 2025
Key facts
- NPI
- 1659059384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701012624 (VA)
- Practice address
- 615 Snidow St
Pembroke, VA 24136-3489 - Phone
- (540) 626-4052
- NPI assigned
- Jul 11, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
323 Old Schoolhouse Rd
Eggleston, VA 24086-3052
Phone (276) 233-4110
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240111000490 | VA | Practitioner - Mental Health Counselor | 5799136065 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701012624 | VA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Waters Counseling Center | Professional | Current |
Accepting new patients |
| Lionmark Counseling LLC | Professional | Current |
Accepting new patients |
Locations
106 Spring Ave NE
Wise, VA 24293
Phone (276) 533-3193
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0701012624 | VA | |
| Professional Counselor | 101YP2500X | 0701012624 | VA | Yes |
Addresses
Primary practice location
615 Snidow St
Pembroke, VA 24136-3489
Mailing address
615 Snidow St
Pembroke, VA 24136-3489
Phone (540) 626-4052
Other providers in Pembroke, VA
All providers in Pembroke, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.