Provider Demographics
NPI:1043857204
Name:SMITH, DOROTHY JACKSON (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JACKSON
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 1:6121 BLANTYRE RD
Mailing Address - Street 2:
Mailing Address - City:BROAD RUN
Mailing Address - State:VA
Mailing Address - Zip Code:20137-1817
Mailing Address - Country:US
Mailing Address - Phone:540-219-9001
Mailing Address - Fax:
Practice Address - Street 1:54 E LEE ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3325
Practice Address - Country:US
Practice Address - Phone:540-347-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040113861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical