Nicole Leeann Smith
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Coloma, CA
NPI 1336496801 · NPPES record last updated Aug 14, 2012
Key facts
- NPI
- 1336496801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CAS R 10652 (CA)
- Practice address
- 838 Beach CT.
Coloma, CA 95613-0437 - Phone
- (530) 626-7252
- NPI assigned
- Aug 14, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CAS R 10652 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CAS R 10652 | CA | Yes |
Addresses
Primary practice location
838 Beach CT.
Coloma, CA 95613-0437
Mailing address
PO Box 143
Diamond Springs, CA 95619-0143
Phone (530) 903-0648
Other providers in Coloma, CA
- Mark A Hyatt
- Panfilo Ibarra
- Judy Lorraine Johnson-Forseth
- David James Olson
- Progress House, Inc.
- Jeana A. Vancura
All providers in Coloma, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.