Provider Demographics
NPI:1144592460
Name:SMOKE, DENISE SUNNY (CATC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SUNNY
Last Name:SMOKE
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 FIRESTONE BLVD APT P
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5540
Mailing Address - Country:US
Mailing Address - Phone:714-651-8151
Mailing Address - Fax:
Practice Address - Street 1:225 7TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5049
Practice Address - Country:US
Practice Address - Phone:714-206-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020653101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)