Provider Demographics
NPI:1528141868
Name:SMOOT, SUSAN J (LPC NCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STONY POINTE WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657-2672
Mailing Address - Country:US
Mailing Address - Phone:540-550-3884
Mailing Address - Fax:
Practice Address - Street 1:105 STONY POINTE WAY STE 221
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-2672
Practice Address - Country:US
Practice Address - Phone:540-550-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VISENTARAOtherOUTPATIENT PSYCHOTHERAPY
VATRICAREOtherOUTPATIENT PSYCOTHERAPY
VAANTHEM 184671OtherOUTPATIENT PSYCHOTHERAPY
VACIGNAOtherOUTPATIENT PSYCHOTHERAPY