Healthcare Provider Details

I. General information

NPI: 1134052137
Provider Name (Legal Business Name): LAURA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA ROBINSON

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 9TH ST
SANTA MONICA CA
90404-4501
US

IV. Provider business mailing address

8616 GREGORY WAY APT 2
LOS ANGELES CA
90035-1726
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1442140526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: