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General NPI Number Information
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NPI Number | 1518311059
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Entity Type | Individual
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Provider Name | MARCUS DONALD SMITH LPC
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 1645 E 50TH ST APT 4H
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City | CHICAGO
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State | IL
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Zip | 60615-3127
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Country | US
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Telephone | 301-704-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 E 50TH ST APT 4H
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City | CHICAGO
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State | IL
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Zip | 60615-3127
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Country | US
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Telephone | 301-704-1843
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.009266
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License Number State | IL
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