Healthcare Provider Details

I. General information

NPI: 1396476370
Provider Name (Legal Business Name): COURTNEY A SMITH M.A., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7288 HANOVER GREEN DR
MECHANICSVILLE VA
23111-1709
US

IV. Provider business mailing address

27777 INKSTER RD., STE. 100
FARMINGTON HILLS MI
48334
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 855-772-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: