MEDICARE: MS. DEANNA SMITH MS.ED

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	0704007489	VA

General Provider Information

NPI Number	:	1528716859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA SMITH MS.ED

Provider Business Mailing Address
First Line	:	112 CROMWELL PKWY APT 302
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-3599
Country	:	US
Telephone Number	:	757-201-0598
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 ARBORETUM PKWY
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-5402
Country	:	US
Telephone Number	:	804-332-7188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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