Provider Demographics
NPI:1558699983
Name:SMITH, KIMBERLY EVON
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EVON
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SUNSET AVE STE 188
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2074
Mailing Address - Country:US
Mailing Address - Phone:707-422-2121
Mailing Address - Fax:707-422-2962
Practice Address - Street 1:333 SUNSET AVE STE 188
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2074
Practice Address - Country:US
Practice Address - Phone:707-422-2121
Practice Address - Fax:707-422-2962
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor