Provider Demographics
NPI:1073645297
Name:SMITH, CANDIA KATHRYN (DMH)
Entity Type:Individual
Prefix:DR
First Name:CANDIA
Middle Name:KATHRYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MORAGA WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3097
Mailing Address - Country:US
Mailing Address - Phone:925-254-7823
Mailing Address - Fax:
Practice Address - Street 1:61 MORAGA WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3097
Practice Address - Country:US
Practice Address - Phone:925-254-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12502103TA0400X
CAPSY 12502103TC0700X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist