Provider Demographics
NPI:1093852238
Name:SMITH, JOAN MARGARET (PHD, RN, CS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARGARET
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N GEORGE MASON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3675
Mailing Address - Country:US
Mailing Address - Phone:703-228-5077
Mailing Address - Fax:703-228-5234
Practice Address - Street 1:1725 N GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3675
Practice Address - Country:US
Practice Address - Phone:703-228-5077
Practice Address - Fax:703-228-5234
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACNS0015000710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945042Medicaid
VA4945042Medicaid