Healthcare Provider Details

I. General information

NPI: 1063644920
Provider Name (Legal Business Name): CURTIS WADE SMITH MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 MARKET ST 400
SAN FRANCISCO CA
94103-1600
US

IV. Provider business mailing address

184 CLINTON PARK
SAN FRANCISCO CA
94103-2344
US

V. Phone/Fax

Practice location:
  • Phone: 415-487-3113
  • Fax:
Mailing address:
  • Phone: 415-420-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00232032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00232032
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number00232032
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00232032
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00232032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: