Provider Demographics
NPI:1770805178
Name:SMITH, NIKKIAH WYATT (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:NIKKIAH
Middle Name:WYATT
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:NIKKIAH
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:6027 MAINSAIL LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3545
Mailing Address - Country:US
Mailing Address - Phone:703-577-4750
Mailing Address - Fax:
Practice Address - Street 1:5705 LEE FARM LN STE D
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-550-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13985101YP2500X
DCLMFT000115106H00000X
VA0701005472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist