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NPI Code Detail

MEDICARE: ANTOINETTE KATHLEEN SMITH AAC, CDPT

MEDICARE: ANTOINETTE KATHLEEN SMITH AAC, CDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorCG60783142WA
2101YA0400XAddiction (Substance Use Disorder) CounselorCO60802177WA

General Provider Information

NPI Number : 1639656275
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE KATHLEEN SMITH AAC, CDPT
Provider Business Mailing Address
First Line : 1616 S GOLD ST STE 4
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-8930
Country : US
Telephone Number : 360-807-4929
Fax Number :
Provider Business Practice Location Address
First Line : 1616 S GOLD ST STE 4
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-8930
Country : US
Telephone Number : 360-807-4929
Fax Number : 360-807-4160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2018
Last Update Date : 07/26/2018

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Directions to “ ANTOINETTE KATHLEEN SMITH AAC, CDPT” Practice Location

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