MEDICARE: JWSMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205443595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JWSMITH

Provider Business Mailing Address
First Line	:	13005 MARTHAS CHOICE CIR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4704
Country	:	US
Telephone Number	:	240-375-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	13005 MARTHAS CHOICE CIR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4704
Country	:	US
Telephone Number	:	240-375-6440
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	WANDA SMITH
Credential	:	LCSWC
Telephone Number	:	240-375-6440

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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Directions to “JWSMITH ” Practice Location

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