Healthcare Provider Details

I. General information

NPI: 1770361685
Provider Name (Legal Business Name): GABRIEL JAMES SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax: 206-323-0933
Mailing address:
  • Phone: 206-322-7676
  • Fax: 206-323-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number61618751
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number61504588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: