Provider Demographics
NPI:1730642489
Name:SMITH, CATHERINE BUMGARNER (LPC)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:BUMGARNER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CENTRAL PARK BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4941
Mailing Address - Country:US
Mailing Address - Phone:540-412-8613
Mailing Address - Fax:540-566-5151
Practice Address - Street 1:1340 CENTRAL PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4941
Practice Address - Country:US
Practice Address - Phone:540-412-8613
Practice Address - Fax:540-566-5151
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty