Healthcare Provider Details

I. General information

NPI: 1619723525
Provider Name (Legal Business Name): SHEENA A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S 12TH ST STE 110
RICHMOND VA
23219-4035
US

IV. Provider business mailing address

7012 HAVERING WAY
HENRICO VA
23231-7285
US

V. Phone/Fax

Practice location:
  • Phone: 804-997-4476
  • Fax:
Mailing address:
  • Phone: 804-382-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number16154-02-008
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: