Provider Demographics
NPI:1710966734
Name:SMITH, LAUREL A (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HARRIS AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7002
Mailing Address - Country:US
Mailing Address - Phone:206-617-0729
Mailing Address - Fax:
Practice Address - Street 1:1106 HARRIS AVE STE 308
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7002
Practice Address - Country:US
Practice Address - Phone:206-617-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002655Medicaid
NC1307XOtherBC/BS
NC2876656AMedicare ID - Type Unspecified