Individual
SHANIKA LAVONDA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18444 BLACK CREEK RD, FRANKLIN, VA 23851-3627
(757) 742-2362
Mailing address
18444 BLACK CREEK RD, FRANKLIN, VA 23851-3627
(757) 742-2362
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710103685
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0711000491
VA
251C00000X
Developmentally Disabled Services Day Training Agency
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07161997
—
VA
Enumeration date
03/12/2019
Last updated
05/19/2022
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