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General NPI Number Information
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NPI Number | 1932720273
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Entity Type | Individual
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Provider Name | JESSICA SMITH
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Gender | Female
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 2107 LAUREL BUSH RD STE 102
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City | BEL AIR
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State | MD
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Zip | 21015-5202
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Country | US
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Telephone | 443-371-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 RAYNHAM CT
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City | BALDWIN
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State | MD
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Zip | 21013-9519
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Country | US
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Telephone |
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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 | LC8331
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License Number State | MD
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