Provider Demographics
NPI:1447983259
Name:SMITH, ADAM MACDONALD BEAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MACDONALD BEAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADAM SMITH
Mailing Address - Street 1:9924 AGINCOURT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-3943
Mailing Address - Country:US
Mailing Address - Phone:804-513-5223
Mailing Address - Fax:
Practice Address - Street 1:9924 AGINCOURT LN
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-3943
Practice Address - Country:US
Practice Address - Phone:804-513-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional