Provider Demographics
NPI:1003112228
Name:SMITH, NORMAN WAYNE SR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:WAYNE
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 KAHLER WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7685
Mailing Address - Country:US
Mailing Address - Phone:240-380-9957
Mailing Address - Fax:
Practice Address - Street 1:309 KAHLER WAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7685
Practice Address - Country:US
Practice Address - Phone:240-380-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685229Medicaid