Healthcare Provider Details

I. General information

NPI: 1942159561
Provider Name (Legal Business Name): STEPHEN SMITH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 INNSLAKE DR STE 211
GLEN ALLEN VA
23060-3324
US

IV. Provider business mailing address

3803 HANOVER AVE
RICHMOND VA
23221-2007
US

V. Phone/Fax

Practice location:
  • Phone: 804-303-9622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: