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General NPI Number Information
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NPI Number | 1033657499
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Entity Type | Individual
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Provider Name | LA TOYA BIANCA SMITH PHD
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 331 GAMBRILLS RD STE 4B
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City | GAMBRILLS
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State | MD
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Zip | 21054-1141
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Country | US
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Telephone | 410-989-3558
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Fax | 443-926-5998
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Provider Business Mailing Address
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Address Line | 2657G ANNAPOLIS RD # 124
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City | HANOVER
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State | MD
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Zip | 21076-1262
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Country | US
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Telephone | 410-989-3558
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Fax | 443-926-5998
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 05744
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License Number State | MD
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