Healthcare Provider Details

I. General information

NPI: 1568795680
Provider Name (Legal Business Name): SHAWN S SMITH MS, LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FROSTBURG STATE UNIVERSITY, EHSC SUITE 118 101 BRADDOCK ROAD
FROSTBURG MD
21532-2303
US

IV. Provider business mailing address

PO BOX 3015
LAVALE MD
21504-3015
US

V. Phone/Fax

Practice location:
  • Phone: 301-687-4234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17104
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: