Healthcare Provider Details

I. General information

NPI: 1356008932
Provider Name (Legal Business Name): CLAUDIA C SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 H ST
CRESCENT CITY CA
95531-3722
US

IV. Provider business mailing address

508 H ST
CRESCENT CITY CA
95531-3722
US

V. Phone/Fax

Practice location:
  • Phone: 541-425-0999
  • Fax:
Mailing address:
  • Phone: 541-425-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW11171
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCSW11171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: