Provider Demographics
NPI:1073257341
Name:SMITH, DAMITA (MSW, LMHP-S)
Entity Type:Individual
Prefix:
First Name:DAMITA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LMHP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HICKORY POINT BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1539
Mailing Address - Country:US
Mailing Address - Phone:804-919-2620
Mailing Address - Fax:
Practice Address - Street 1:2021B CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3326
Practice Address - Country:US
Practice Address - Phone:757-262-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906009753101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health