Individual
GEORGIANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5040 VIRGINIA BEACH BLVD, VIRGINIA BEACH, VA 23462-6637
(757) 343-9573
Mailing address
5040 VIRGINIA BEACH BLVD, VIRGINIA BEACH, VA 23462-6637
(757) 343-9573
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
2772
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2772
—
VA
Enumeration date
10/30/2019
Last updated
10/30/2019
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