Healthcare Provider Details

I. General information

NPI: 1184382301
Provider Name (Legal Business Name): ENIJAH SMITH-JOE LICSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PENNSYLVANIA AVE NW
WASHINGTON DC
20004-2601
US

IV. Provider business mailing address

2950 BELCREST CENTER DR UNIT 1096
HYATTSVILLE MD
20782-1912
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone: 301-531-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119753
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200001657
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029378
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: