Provider Demographics
NPI:1689335457
Name:SMITH, BEVERLY T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:T
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 1:9 KNODISHALL WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1967
Mailing Address - Country:US
Mailing Address - Phone:757-506-5812
Mailing Address - Fax:
Practice Address - Street 1:9 KNODISHALL WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-1967
Practice Address - Country:US
Practice Address - Phone:757-506-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical