Provider Demographics
NPI:1194358697
Name:SMITH, YVETTA DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:YVETTA
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 BALLS FORD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109
Mailing Address - Country:US
Mailing Address - Phone:703-867-3754
Mailing Address - Fax:
Practice Address - Street 1:10432 BALLS FORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-867-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional