Provider Demographics
NPI:1790929008
Name:SMITH, ASHLEY RENEE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
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 1:116 PASEO DE LA CONCHA
Mailing Address - Street 2:APT. #8
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6207
Mailing Address - Country:US
Mailing Address - Phone:805-796-0316
Mailing Address - Fax:
Practice Address - Street 1:695 S. VERMONT AVE.
Practice Address - Street 2:LOS ANGELES COUNTY DEPT. OF MENTAL HEALTH
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005
Practice Address - Country:US
Practice Address - Phone:805-796-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3837415390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program