Provider Demographics
NPI:1033725239
Name:SMITH, DESIREE DEVONNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:DEVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 CAPPAHOSIC RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3300
Mailing Address - Country:US
Mailing Address - Phone:757-214-2934
Mailing Address - Fax:
Practice Address - Street 1:3568 LADD AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4217
Practice Address - Country:US
Practice Address - Phone:757-214-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040148431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical