Healthcare Provider Details

I. General information

NPI: 1750116125
Provider Name (Legal Business Name): JOEL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 JEFFERSON ST NW
WASHINGTON DC
20011-7711
US

IV. Provider business mailing address

509 JEFFERSON ST NW
WASHINGTON DC
20011-7711
US

V. Phone/Fax

Practice location:
  • Phone: 771-216-6122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: