Doctor Name: | KRISTEN ELISE SMITH |
NPI Number: | 1174942254 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 0904008400 |
Business Practice Address: | 1901 Advantage Drive Stuite B Prince George, VA - 23804 |
Business Phone Number: | 8047346383 |
Business Fax Number: | |
Mailing Address: | Po Box 5715, MIDLOTHIAN |
State: | VA |
Postal Code: | 23112 |
Phone Number: | 8043790400 |
Fax Number: | 8044147736 |
NPI Enumeration Date: | 04/16/2014 |
NPI Last Update Date: | 01/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 0904008400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |