Provider Demographics
NPI:1720165129
Name:SCHELL-SMITH, MICHAEL D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:SCHELL-SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7969 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2885
Mailing Address - Country:US
Mailing Address - Phone:703-792-7800
Mailing Address - Fax:703-792-5699
Practice Address - Street 1:601 JEFFERSON DAVIS HWY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4564
Practice Address - Country:US
Practice Address - Phone:703-490-0336
Practice Address - Fax:703-490-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945247Medicaid
VA292895OtherAMERIGROUP
VA210307OtherBLUE CROSS BLUE SHIELD
VA5460015431OtherEIN