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General NPI Number Information
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NPI Number | 1033731112
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Entity Type | Individual
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Provider Name | KRISTINA P SMITH
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Gender | Female
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 280 17TH ST
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City | OAKLAND
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State | CA
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Zip | 94612-4124
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Country | US
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Telephone | 510-514-5948
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 58TH AVE STE 210
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City | DENVER
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State | CO
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Zip | 80216-1400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NLC.0108014
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13563
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License Number State | CA
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