Provider Demographics
NPI:1295834513
Name:SMITH, SARA KATHARINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:KATHARINE
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 1:3004 OAKLEY HALL RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4518
Mailing Address - Country:US
Mailing Address - Phone:757-393-0061
Mailing Address - Fax:757-398-0340
Practice Address - Street 1:1801 PORTSMOUTH BLVD
Practice Address - Street 2:PINES RTC
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-6323
Practice Address - Country:US
Practice Address - Phone:757-398-0430
Practice Address - Fax:757-398-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8931658Medicaid
VA8931640Medicaid
VA8923213Medicaid