Provider Demographics
NPI:1376566000
Name:SMITH, DEBBIE C (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:C
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 1:3433 BRAMBLETON AVE
Mailing Address - Street 2:SUITE 109-B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6515
Mailing Address - Country:US
Mailing Address - Phone:540-989-9537
Mailing Address - Fax:540-989-3498
Practice Address - Street 1:3433 BRAMBLETON AVE
Practice Address - Street 2:SUITE 109-B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6515
Practice Address - Country:US
Practice Address - Phone:540-989-9537
Practice Address - Fax:540-989-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040012481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019335OtherVALUE OPTIONS
VA4594702OtherAETNA
VA66676OtherCIGNA BEHAVIORAL HEALTH
VA096014OtherANTHEM