Provider Demographics
NPI:1225523624
Name:SMITH, SHARLINE MAYA (APCC)
Entity Type:Individual
Prefix:MRS
First Name:SHARLINE
Middle Name:MAYA
Last Name:SMITH
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:SHARLINE
Other - Middle Name:MAYA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3840 ROSIN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1639
Mailing Address - Country:US
Mailing Address - Phone:916-921-0828
Mailing Address - Fax:
Practice Address - Street 1:3840 ROSIN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1639
Practice Address - Country:US
Practice Address - Phone:916-921-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15974101YP2500X
390200000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program