Provider Demographics
NPI:1134828833
Name:SMITH, CHELSEA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
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 1:23410 18TH AVE S APT K202
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7592
Mailing Address - Country:US
Mailing Address - Phone:360-440-2397
Mailing Address - Fax:
Practice Address - Street 1:23410 18TH AVE S APT K202
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7592
Practice Address - Country:US
Practice Address - Phone:360-440-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW613632041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty