Provider Demographics
NPI:1073042735
Name:SMITH, ALEXANDRIA EVALEEN (ACSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:EVALEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACSW, MSW
Other - Prefix:MS
Other - First Name:ALEXANDRIA
Other - Middle Name:EVALEEN
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3609 OCEAN RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2698
Mailing Address - Country:US
Mailing Address - Phone:760-418-4611
Mailing Address - Fax:
Practice Address - Street 1:3609 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2698
Practice Address - Country:US
Practice Address - Phone:760-418-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84890101YA0400X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health