Provider Demographics
NPI:1114641032
Name:SMITH, ALEXIS COLE (ASW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:COLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:COLE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3541 KENORA DR APT C2
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2911
Mailing Address - Country:US
Mailing Address - Phone:484-784-7559
Mailing Address - Fax:
Practice Address - Street 1:2279 4TH AVENUE
Practice Address - Street 2:#3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-948-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104965104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker