Provider Demographics
NPI:1134914906
Name:SMITH, JAQUANA
Entity type:Individual
Prefix:
First Name:JAQUANA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CITY CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6666
Mailing Address - Country:US
Mailing Address - Phone:757-472-0589
Mailing Address - Fax:
Practice Address - Street 1:575 LYNNHAVEN PKWY STE 305
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7350
Practice Address - Country:US
Practice Address - Phone:833-329-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health