Provider Demographics
NPI:1679025365
Name:WILSON SMITH, KATHRINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:WILSON SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WILSON SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4948 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2205
Mailing Address - Country:US
Mailing Address - Phone:916-600-6285
Mailing Address - Fax:
Practice Address - Street 1:4948 23RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2205
Practice Address - Country:US
Practice Address - Phone:916-600-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27789101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27789OtherLCSW