Provider Demographics
NPI:1265113856
Name:SMITH, VICKIE L (MFT, LPC)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-2931
Mailing Address - Country:US
Mailing Address - Phone:215-868-6688
Mailing Address - Fax:
Practice Address - Street 1:211 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-2931
Practice Address - Country:US
Practice Address - Phone:215-868-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00332800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health