Provider Demographics
NPI:1437455003
Name:SMITH, CYNTHIA JOI (A015040315)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JOI
Last Name:SMITH
Suffix:
Gender:F
Credentials:A015040315
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JOI
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40925 COUNTY CENTER DR. SUITE 100 & 200
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-256-7660
Mailing Address - Fax:
Practice Address - Street 1:40925 COUNTY CENTER DR. SUITE 100 & 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-600-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA15040315171M00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator