Healthcare Provider Details

I. General information

NPI: 1891668422
Provider Name (Legal Business Name): DESTINY SMITH- BROWN PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESTINY SMITH PPSC

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CENTRAL AVE
ALAMEDA CA
94501-3246
US

IV. Provider business mailing address

210 CENTRAL AVE
ALAMEDA CA
94501-3246
US

V. Phone/Fax

Practice location:
  • Phone: 510-748-4023
  • Fax:
Mailing address:
  • Phone: 510-748-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240064278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: