Healthcare Provider Details

I. General information

NPI: 1902284151
Provider Name (Legal Business Name): MRS. SADARIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S VALLEY VIEW BLVD STE 6
LAS VEGAS NV
89102-0166
US

IV. Provider business mailing address

5175 JERRY TARKANIAN WAY
LAS VEGAS NV
89148-5163
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 702-540-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02260-I
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7559-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: