Provider Demographics
NPI:1245771708
Name:SMITH, ROBERT CHRISTOPHER JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4618
Mailing Address - Country:US
Mailing Address - Phone:209-533-6245
Mailing Address - Fax:408-259-2273
Practice Address - Street 1:105 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4618
Practice Address - Country:US
Practice Address - Phone:209-533-6245
Practice Address - Fax:408-259-2273
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health