Provider Demographics
NPI:1629518840
Name:SMITH, RAYMOND (LCSW-C, , LCSW, QCSW)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW-C, , LCSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 KEMPSRIVER DR UNIT 1027
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5369
Mailing Address - Country:US
Mailing Address - Phone:667-299-6185
Mailing Address - Fax:
Practice Address - Street 1:2726 SAINT MIHIEL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1715
Practice Address - Country:US
Practice Address - Phone:667-299-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2166871041C0700X
MALICSW1267151041C0700X
VA09040141041C0700X
DCLC500827181041C0700X
MD196991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical