Provider Demographics
NPI:1104046077
Name:SMITH, ANN VIRGINIA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:VIRGINIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1624
Mailing Address - Country:US
Mailing Address - Phone:410-493-5372
Mailing Address - Fax:
Practice Address - Street 1:1406 B CRAIN HWY
Practice Address - Street 2:SUITE 206 BALTIMORE WASHINGTON COUNSELING CENTER
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-6088
Practice Address - Fax:410-768-6444
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical