Provider Demographics
NPI:1356463525
Name:SMITH, VIRGINIA (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MAPLE AVE W
Mailing Address - Street 2:SUITE 303 B
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5620
Mailing Address - Country:US
Mailing Address - Phone:703-938-5234
Mailing Address - Fax:703-938-2949
Practice Address - Street 1:380 MAPLE AVE W
Practice Address - Street 2:SUITE 303 B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5620
Practice Address - Country:US
Practice Address - Phone:703-938-5234
Practice Address - Fax:703-938-2949
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001759103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent