Healthcare Provider Details

I. General information

NPI: 1609005123
Provider Name (Legal Business Name): CRISELDA G SMITH MA, LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 340682
SAN ANTONIO TX
78234-0682
US

IV. Provider business mailing address

7300 BLANCO RD STE 501
SAN ANTONIO TX
78216-4941
US

V. Phone/Fax

Practice location:
  • Phone: 808-342-2613
  • Fax:
Mailing address:
  • Phone: 210-446-8255
  • Fax: 888-823-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11170
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: