Provider Demographics
NPI:1578980926
Name:SMITH, MICHELLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SMITH FUKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5882
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92165-5882
Mailing Address - Country:US
Mailing Address - Phone:858-522-0956
Mailing Address - Fax:858-987-8656
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3784
Practice Address - Country:US
Practice Address - Phone:858-522-0956
Practice Address - Fax:858-987-8656
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA815031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical