Provider Demographics
NPI:1215196712
Name:SMITH, LACRETIA
Entity Type:Individual
Prefix:
First Name:LACRETIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACRETIA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 W ORANGEWOOD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2051
Mailing Address - Country:US
Mailing Address - Phone:714-383-9359
Mailing Address - Fax:714-383-9259
Practice Address - Street 1:1845 W ORANGEWOOD AVE
Practice Address - Street 2:STE 300
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2051
Practice Address - Country:US
Practice Address - Phone:714-383-9359
Practice Address - Fax:714-383-9259
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health