Provider Demographics
NPI:1396290300
Name:SMITH, DONOVAN JAMEZ (MA SPSY , CAS)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:JAMEZ
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA SPSY , CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YOAKUM PKWY APT 1120
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4060
Mailing Address - Country:US
Mailing Address - Phone:757-971-3108
Mailing Address - Fax:
Practice Address - Street 1:2200 MINNESOTA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5324
Practice Address - Country:US
Practice Address - Phone:202-645-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool