Healthcare Provider Details

I. General information

NPI: 1275468647
Provider Name (Legal Business Name): DIADRA SMITH LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SEPULVEDA BLVD STE 280
MANHATTAN BEACH CA
90266-5975
US

IV. Provider business mailing address

1620 VENICE BLVD APT 301
VENICE CA
90291-5933
US

V. Phone/Fax

Practice location:
  • Phone: 562-277-1965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DIADRA SMITH
Title or Position: OWNER
Credential: LCSW
Phone: 562-277-1965