Provider Demographics
NPI:1376667071
Name:SMOOT, JOHANNA E (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:E
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BROADWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2112
Mailing Address - Country:US
Mailing Address - Phone:301-838-9489
Mailing Address - Fax:301-838-9489
Practice Address - Street 1:9037 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-221-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21BNJOOtherBCBS PROVIDER NUMBER
MDLC2225OtherMD LICENSED PROFFESSIONAL
MD5572OtherBLUECROSS BLUE SHIELD PRO