Provider Demographics
NPI:1760930168
Name:SMITH, WHITNEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
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 1:340 E PINNER ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3746
Mailing Address - Country:US
Mailing Address - Phone:252-287-5870
Mailing Address - Fax:
Practice Address - Street 1:340 E PINNER ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-3746
Practice Address - Country:US
Practice Address - Phone:252-287-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040118901041C0700X
NC58-1716970101Y00000X
NCP0119961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760930168Medicaid
VA1396414413Medicaid