Provider Demographics
NPI:1174766836
Name:SMITH, SHAWN B (LCPC, LCADC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 REISTERSTOWN RD
Mailing Address - Street 2:SUITE L-2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6502
Mailing Address - Country:US
Mailing Address - Phone:410-653-6300
Mailing Address - Fax:410-653-6300
Practice Address - Street 1:1401 REISTERSTOWN RD
Practice Address - Street 2:SUITE L-2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6502
Practice Address - Country:US
Practice Address - Phone:410-653-6300
Practice Address - Fax:410-653-6300
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA462101YA0400X
MDLC2546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)