Healthcare Provider Details

I. General information

NPI: 1891768263
Provider Name (Legal Business Name): AMY B SMITH LPC, MAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

803 17TH ST SE
WASHINGTON DC
20003-3128
US

V. Phone/Fax

Practice location:
  • Phone: 202-210-0607
  • Fax:
Mailing address:
  • Phone: 202-547-8667
  • Fax: 202-547-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13763
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: