Provider Demographics
NPI:1568479111
Name:SMITH, ANGELA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N COURTHOUSE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4069
Mailing Address - Country:US
Mailing Address - Phone:804-794-4482
Mailing Address - Fax:804-379-7578
Practice Address - Street 1:703 N COURTHOUSE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4069
Practice Address - Country:US
Practice Address - Phone:804-794-4482
Practice Address - Fax:804-379-7578
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007706278Medicaid