Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC3823 | MD |
NPI | 1003112228 |
---|---|
Provider Name | Mr. Norman Wayne Smith SR. |
First Address | Glen Burnie, MD 21060-7685 |
Second Address | Gaithersburg, MD 20877-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2011 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
685229 | (05) | MD |