Provider Demographics
NPI:1235353004
Name:SMITH, MARY ANGELA (LMHC, CSAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC, CSAC
Other - Prefix:
Other - First Name:M.
Other - Middle Name:ANGELA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 700522
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-0522
Mailing Address - Country:US
Mailing Address - Phone:808-349-1137
Mailing Address - Fax:
Practice Address - Street 1:1311 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4502
Practice Address - Country:US
Practice Address - Phone:808-349-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI979-99R101YA0400X
HIMHC 120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)