Healthcare Provider Details

I. General information

NPI: 1316016033
Provider Name (Legal Business Name): MS. SONYA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD 1ST FLOOR
COMPTON CA
90221-3303
US

IV. Provider business mailing address

PO BOX 59182
LOS ANGELES CA
90059-0182
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6990
  • Fax:
Mailing address:
  • Phone: 323-567-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: