Provider Demographics
NPI:1700114774
Name:SMITH, KRISTINA R (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 MILL RACE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10451 TWIN RIVERS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2388
Practice Address - Country:US
Practice Address - Phone:443-325-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical