Provider Demographics
NPI:1225228208
Name:SMITH, RICHARD LYN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GEORGIA ST STE 355
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5971
Mailing Address - Country:US
Mailing Address - Phone:707-558-8195
Mailing Address - Fax:707-558-8196
Practice Address - Street 1:301 GEORGIA ST STE 355
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5971
Practice Address - Country:US
Practice Address - Phone:707-558-8195
Practice Address - Fax:707-558-8196
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)