Provider Demographics
NPI:1972717064
Name:SMITH, DAVID LINDSAY (MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LINDSAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 COLUSA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707
Mailing Address - Country:US
Mailing Address - Phone:510-524-9500
Mailing Address - Fax:510-845-0446
Practice Address - Street 1:376 COLUSA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94707
Practice Address - Country:US
Practice Address - Phone:510-524-9500
Practice Address - Fax:510-845-0446
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist