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General NPI Number Information
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NPI Number | 1013326214
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Entity Type | Individual
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Provider Name | DEANDRA SMITH RBT
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 111 BULIFANTS BLVD STE B
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City | WILLIAMSBURG
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State | VA
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Zip | 23188
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Country | US
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Telephone | 757-645-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 763 J CLYDE MORRIS BLVD STE 1C
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1533
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Country | US
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Telephone | 434-806-6281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | T62056286
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-26722
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License Number State | VA
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