Provider Demographics
NPI:1730991233
Name:SMITH, KATARA LYNN (MSW QMHP-A QMHP-C)
Entity type:Individual
Prefix:
First Name:KATARA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW QMHP-A QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7021
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0021
Mailing Address - Country:US
Mailing Address - Phone:757-944-3309
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 7021
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-0021
Practice Address - Country:US
Practice Address - Phone:757-944-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732004982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health