Provider Demographics
NPI:1598390973
Name:SMITH, BRITTNEY LEIGH (R1358670819)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:R1358670819
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BAKER CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1504
Mailing Address - Country:US
Mailing Address - Phone:707-980-3938
Mailing Address - Fax:
Practice Address - Street 1:3707 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6101
Practice Address - Country:US
Practice Address - Phone:925-522-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1358670819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)