Healthcare Provider Details

I. General information

NPI: 1780906156
Provider Name (Legal Business Name): ALIA ALI SMITH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 06/27/2024
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BAILEY AVE
NEEDLES CA
92363-3105
US

IV. Provider business mailing address

1600 BAILEY AVE
NEEDLES CA
92363-3105
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-9313
  • Fax:
Mailing address:
  • Phone: 760-326-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number102291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT101247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: