Provider Demographics
NPI:1316230840
Name:SMITH, HARRY T (LCPC, LCADC)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 W LANVALE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-4805
Mailing Address - Country:US
Mailing Address - Phone:410-350-9729
Mailing Address - Fax:
Practice Address - Street 1:2546 W LANVALE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4805
Practice Address - Country:US
Practice Address - Phone:410-350-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSC1598OtherALCOHOL AND DRUG LICENSE