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General NPI Number Information
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NPI Number | 1134776529
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Entity Type | Individual
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Provider Name | JOANNA SMITH LPC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 9023 FOREST HILL AVE STE 2A
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3054
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Country | US
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Telephone | 804-416-5052
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Fax | 804-800-2423
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Provider Business Mailing Address
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Address Line | 2508 HAVARD RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-4209
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Country | US
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Telephone | 321-432-3211
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704009808
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701009425
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License Number State | VA
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