Provider Demographics
NPI:1386019867
Name:SMITH, STEPHEN WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 CHESTER FOREST CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7709
Mailing Address - Country:US
Mailing Address - Phone:757-708-0241
Mailing Address - Fax:
Practice Address - Street 1:2716 CHESTER FOREST CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7709
Practice Address - Country:US
Practice Address - Phone:757-708-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical