Provider Demographics
NPI:1336491414
Name:SMITH, BRENDA R (LPCMH, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17596 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4427
Mailing Address - Country:US
Mailing Address - Phone:302-569-2519
Mailing Address - Fax:
Practice Address - Street 1:17596 DAVIS RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4427
Practice Address - Country:US
Practice Address - Phone:302-569-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000597101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor