Provider Demographics
NPI:1366655615
Name:SMITH, MICHELE YVETTE (P-LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 CHESTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2870
Mailing Address - Country:US
Mailing Address - Phone:757-285-9893
Mailing Address - Fax:
Practice Address - Street 1:3954 CHESTERWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2870
Practice Address - Country:US
Practice Address - Phone:757-285-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0031541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical