Healthcare Provider Details

I. General information

NPI: 1083573562
Provider Name (Legal Business Name): LACHANDA SMALLS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W WHITE HORSE PIKE STE 1B
BERLIN NJ
08009-2028
US

IV. Provider business mailing address

10 E 4TH AVE
PINE HILL NJ
08021-6206
US

V. Phone/Fax

Practice location:
  • Phone: 856-352-5424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL05873200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05873200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: