Provider Demographics
NPI:1043630973
Name:SMITH, SOLOMON A (MENTAL HEALTH TECH)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MENTAL HEALTH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 FIRE POPPY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2848
Mailing Address - Country:US
Mailing Address - Phone:916-549-2678
Mailing Address - Fax:
Practice Address - Street 1:5820 FIRE POPPY DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-2848
Practice Address - Country:US
Practice Address - Phone:916-549-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator