Healthcare Provider Details

I. General information

NPI: 1720891658
Provider Name (Legal Business Name): MADISON SMART-MCCARTHY LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MCLAWS CIR
WILLIAMSBURG VA
23185-5649
US

IV. Provider business mailing address

2202 EXECUTIVE DR STE C
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-3100
  • Fax:
Mailing address:
  • Phone: 757-827-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12444
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008776
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: