Healthcare Provider Details

I. General information

NPI: 1710800263
Provider Name (Legal Business Name): TAMICKA SMITHSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 E FORT AVE
BALTIMORE MD
21230-5117
US

IV. Provider business mailing address

841 E FORT AVE
BALTIMORE MD
21230-5117
US

V. Phone/Fax

Practice location:
  • Phone: 240-548-7680
  • Fax:
Mailing address:
  • Phone: 240-548-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC17979
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC17979
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC17979
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: