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General NPI Number Information
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NPI Number | 1174042006
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Entity Type | Individual
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Provider Name | CHANTEL SMITH PHD, MSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 603 POST OFFICE RD STE 307
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City | WALDORF
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State | MD
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Zip | 20602-1914
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Country | US
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Telephone | 240-263-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 9606 PEP RALLY LN
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City | WALDORF
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State | MD
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Zip | 20603-5354
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Country | US
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Telephone | 240-441-5539
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22115
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License Number State | MD
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