Provider Demographics
NPI:1730441296
Name:SMITH, STACEY S (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:O'TOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 BURLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3413
Mailing Address - Country:US
Mailing Address - Phone:757-625-5598
Mailing Address - Fax:757-585-3521
Practice Address - Street 1:821 W 21ST ST STE 209
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1500
Practice Address - Country:US
Practice Address - Phone:757-625-5598
Practice Address - Fax:757-585-3521
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040079521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical