Healthcare Provider Details

I. General information

NPI: 1336700202
Provider Name (Legal Business Name): COLLEEN COPELAND SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40935 GRENATA PRESERVE PL
LEESBURG VA
20175-8720
US

IV. Provider business mailing address

40935 GRENATA PRESERVE PL
LEESBURG VA
20175-8720
US

V. Phone/Fax

Practice location:
  • Phone: 571-206-4252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: