Individual
MS. LISA D SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
93 S MCCAIN DR, FREDERICK, MD 21703-6007
(410) 597-8788
Mailing address
2603 N ROLLING RD, SUITE 301, BALTIMORE, MD 21244-1975
(410) 597-8788
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
06000
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216211300
—
MD
Enumeration date
11/03/2008
Last updated
11/03/2008
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