MEDICARE: MRS. ELIZABETH DAIGLE SMITH LCSW

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	1041C0700X	Clinical Social Worker	0904017301	VA
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1720274384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH DAIGLE SMITH LCSW

Provider Business Mailing Address
First Line	:	6355 WALKER LN STE 401
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	571-480-4764
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 401
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	571-480-4764
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	03/11/2025

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