Provider Demographics
NPI:1184752966
Name:SMITH, EIREANN ELIZABETH (106H00000X)
Entity type:Individual
Prefix:MS
First Name:EIREANN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:106H00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2914
Mailing Address - Country:US
Mailing Address - Phone:916-224-0844
Mailing Address - Fax:
Practice Address - Street 1:110 GATEWAY OAKS DRIVE, SUITE 210
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:916-645-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist