Provider Demographics
NPI:1821211699
Name:SMITH, GREGORY E (LCPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C NORTH AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2330
Mailing Address - Country:US
Mailing Address - Phone:410-638-7088
Mailing Address - Fax:410-838-6453
Practice Address - Street 1:4C NORTH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2330
Practice Address - Country:US
Practice Address - Phone:410-638-7088
Practice Address - Fax:410-838-6453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health