Provider Demographics
NPI:1740789346
Name:SMILEY, MARK L (MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9600 LABRADOR LN
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1715
Mailing Address - Country:US
Mailing Address - Phone:443-281-3755
Mailing Address - Fax:443-353-9894
Practice Address - Street 1:8831 SATYR HILL RD STE 211
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2308
Practice Address - Country:US
Practice Address - Phone:443-281-3755
Practice Address - Fax:443-353-9894
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDLC9415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health