Provider Demographics
NPI:1942759204
Name:SMITH, VIRGINIA YASMINE (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:YASMINE
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 1:13130 LAKEWIND DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5334
Mailing Address - Country:US
Mailing Address - Phone:352-227-8456
Mailing Address - Fax:
Practice Address - Street 1:13350 W COLONIAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3964
Practice Address - Country:US
Practice Address - Phone:407-654-4433
Practice Address - Fax:407-926-0209
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical