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General NPI Number Information
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NPI Number | 1982792677
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Entity Type | Individual
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Provider Name | DALE EDWARD SMITH M.A.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER, PERRY POINT 1H CIRCLE DRIVE BUILDING
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City | PERRY POINT
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State | MD
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Zip | 21902
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Country | US
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Telephone | 410-642-2411
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Fax | 410-642-1852
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Provider Business Mailing Address
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Address Line | 704 DEEP RIDGE RD
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City | BEL AIR
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State | MD
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Zip | 21014-5292
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Country | US
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Telephone | 410-642-2411
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Fax | 410-642-1852
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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 | LC0111
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License Number State | MD
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