Provider Demographics
NPI:1174042006
Name:SMITH, CHANTEL (PHD, MSW, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9606 PEP RALLY LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5354
Mailing Address - Country:US
Mailing Address - Phone:240-441-5539
Mailing Address - Fax:
Practice Address - Street 1:603 POST OFFICE RD STE 307
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:240-263-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker