Individual provider Active NPI

Denise M Smith, SUDCC

  • Addiction (Substance Use Disorder) Counselor
  • Stockton, CA
National Provider Identifier
1932773579
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
7568 Issued in CA
Practice address
1981 Cherokee Rd
Stockton, CA 95205-2720
Phone
(209) 870-6525
Fax
(209) 337-2108
NPI assigned
May 18, 2021
Last updated
May 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 7568 CA Primary

Addresses

Primary practice location

1981 Cherokee Rd
Stockton, CA 95205-2720

Mailing address

1981 Cherokee Rd
Stockton, CA 95205-2720
Phone (209) 870-6525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7568CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Alcohol & Drug Awareness Program PastSince May 25, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1932773579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1981 CHEROKEE RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952052720",
            "telephone_number": "209-870-6525",
            "fax_number": "209-337-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1981 CHEROKEE RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952052720",
            "telephone_number": "209-870-6525",
            "fax_number": "209-337-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DENISE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "SUDCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "7568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.