Provider Demographics
NPI:1043034226
Name:SMITH, JEAN MILLER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MILLER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47561 ANCHORAGE CIR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4716
Mailing Address - Country:US
Mailing Address - Phone:302-897-2528
Mailing Address - Fax:
Practice Address - Street 1:312 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4100
Practice Address - Country:US
Practice Address - Phone:302-897-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040175621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical