Provider Demographics
NPI:1689935744
Name:SMITH, BEVERLY R (NCC, LCPC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCC, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4496
Mailing Address - Country:US
Mailing Address - Phone:240-326-3942
Mailing Address - Fax:
Practice Address - Street 1:7606 GEORGIAN DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4496
Practice Address - Country:US
Practice Address - Phone:301-856-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1057101YP2500X
DCPRC13604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional