Healthcare Provider Details

I. General information

NPI: 1053238717
Provider Name (Legal Business Name): KEONA SMITH LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6628 HARFORD RD
BALTIMORE MD
21214-1303
US

IV. Provider business mailing address

813 DERWENT LN
SALISBURY MD
21801-2592
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-5612
  • Fax:
Mailing address:
  • Phone: 443-438-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP13727
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: