Provider Demographics
NPI:1356392476
Name:SMITH, ARACOMA S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ARACOMA
Middle Name:S
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 1:3715 LATIMERS KNOLL CT STE 103
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7361
Mailing Address - Country:US
Mailing Address - Phone:540-361-1844
Mailing Address - Fax:540-361-1874
Practice Address - Street 1:3715 LATIMERS KNOLL CT STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7361
Practice Address - Country:US
Practice Address - Phone:540-361-1844
Practice Address - Fax:540-361-1874
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA267533OtherANTHEM BC & BS
VAP31371Medicare UPIN
VA00X361A01Medicare PIN