Provider Demographics
NPI:1083131148
Name:SMITH-SEPOLEN, VINITA DENISE
Entity Type:Individual
Prefix:
First Name:VINITA
Middle Name:DENISE
Last Name:SMITH-SEPOLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 LINFIELD DR.
Mailing Address - Street 2:373 LINFIELD DR.
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589
Mailing Address - Country:US
Mailing Address - Phone:707-644-6766
Mailing Address - Fax:707-644-6766
Practice Address - Street 1:1628 BROADWAY
Practice Address - Street 2:373 LINFIELD DR.
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:707-649-8300
Practice Address - Fax:707-649-8302
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty