Healthcare Provider Details

I. General information

NPI: 1639574437
Provider Name (Legal Business Name): KACI SMITH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

V. Phone/Fax

Practice location:
  • Phone: 510-746-2800
  • Fax: 510-746-2810
Mailing address:
  • Phone: 510-746-2800
  • Fax: 510-746-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: