Provider Demographics
NPI:1407443666
Name:SMITH, DEITRE (LPC)
Entity Type:Individual
Prefix:
First Name:DEITRE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:DEITRE
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WILLIAMS
Mailing Address - Street 1:702 RAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6434
Mailing Address - Country:US
Mailing Address - Phone:757-685-4681
Mailing Address - Fax:
Practice Address - Street 1:702 RAY AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6434
Practice Address - Country:US
Practice Address - Phone:757-685-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010828101YM0800X
VA0704010252390200000X
VA0710103460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program