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General NPI Number Information
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NPI Number | 1841866944
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Entity Type | Individual
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Provider Name | MARTELL DAMON SMITH
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Gender | Male
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 2133 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-2385
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Country | US
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Telephone | 206-348-0490
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Fax |
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Provider Business Mailing Address
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Address Line | 2117 NE 16TH ST
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City | RENTON
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State | WA
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Zip | 98056-2756
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Country | US
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Telephone | 808-649-8848
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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 |
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License Number State |
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