Provider Demographics
NPI:1801338348
Name:SMARTT, ASHLEY RAQUELLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAQUELLE
Last Name:SMARTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAQUELLE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2991 SACRAMENTO ST UNIT 269
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2534
Mailing Address - Country:US
Mailing Address - Phone:510-457-1183
Mailing Address - Fax:
Practice Address - Street 1:614 GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3554
Practice Address - Country:US
Practice Address - Phone:844-638-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 96288106H00000X
CA117055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist