=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851369011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOKASONIA SYDNOR SMITH LCSWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1411 JEFFERSON DAVIS HWY
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22202-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-602-2893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5740 COLD LAKE DR
-----------------------------------------------------
City | WELCOME
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20693-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-934-1538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 12909
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------