MEDICARE: GREGORY E. SMITH LCPC

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	LCO197	MD

General Provider Information

NPI Number	:	1821211699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY E. SMITH LCPC

Provider Business Mailing Address
First Line	:	4C NORTH AVE
Second Line	:	SUITE 403
City	:	BEL AIR
State	:	MD
Zip	:	21014-2330
Country	:	US
Telephone Number	:	410-638-7088
Fax Number	:	410-838-6453

Provider Business Practice Location Address
First Line	:	4C NORTH AVE
Second Line	:	SUITE 403
City	:	BEL AIR
State	:	MD
Zip	:	21014-2330
Country	:	US
Telephone Number	:	410-638-7088
Fax Number	:	410-838-6453

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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