Provider Demographics
NPI:1376014738
Name:SMITH, JANINA (LCSW)
Entity type:Individual
Prefix:
First Name:JANINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NE 3RD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6219
Mailing Address - Country:US
Mailing Address - Phone:503-664-1446
Mailing Address - Fax:503-607-8600
Practice Address - Street 1:405 NE 3RD ST STE 7
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6219
Practice Address - Country:US
Practice Address - Phone:503-664-1446
Practice Address - Fax:503-607-8600
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL10910101YM0800X
WA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500761787Medicaid