Healthcare Provider Details

I. General information

NPI: 1407443666
Provider Name (Legal Business Name): DEITRE M SMITH LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEITRE M SMITH WILLIAMS

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BELAIRE AVE STE 350
CHESAPEAKE VA
23320-4789
US

IV. Provider business mailing address

555 BELAIRE AVE STE 350
CHESAPEAKE VA
23320-4789
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103460
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010828
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: