Provider Demographics
NPI:1124842539
Name:SMITH, SUZETTE VICTORIA
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 COUNTRY MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5270
Mailing Address - Country:US
Mailing Address - Phone:929-282-3911
Mailing Address - Fax:
Practice Address - Street 1:5802 COUNTRY MANOR WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5270
Practice Address - Country:US
Practice Address - Phone:929-282-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker