MEDICARE: BONITA SMITH LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LC9755	MD

General Provider Information

NPI Number	:	1619527926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA SMITH LCPC

Provider Business Mailing Address
First Line	:	12138 CENTRAL AVE STE 163
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1910
Country	:	US
Telephone Number	:	301-379-2792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 EYRE DR N
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3202
Country	:	US
Telephone Number	:	240-639-5240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	12/19/2024

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