Provider Demographics
NPI:1518398874
Name:SMITH, KYLIE D (LCSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:D
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 1:1510 WILLOW LAWN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3429
Mailing Address - Country:US
Mailing Address - Phone:804-359-0613
Mailing Address - Fax:804-359-0614
Practice Address - Street 1:1510 WILLOW LAWN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-359-0613
Practice Address - Fax:804-359-0614
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical