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General NPI Number Information
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NPI Number | 1346719648
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Entity Type | Individual
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Provider Name | CHARMAINE C SMITH-WARDEN BA, BS, MS
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Gender | Female
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 4750 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-2715
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Country | US
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Telephone | 888-949-4864
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 W 4100 S STE 201
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-6490
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CG60813052
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61497402
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8971947
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License Number State |
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