Basic Information
| Provider Information | |||||||||
| NPI: | 1063644920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 CLINTON PARK | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154208096 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1035 MARKET ST | ||||||||
| Address2: | 400 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154873113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 00232032 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | 00232032 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 174H00000X | 00232032 | CA | N | Other Service Providers | Health Educator | 101YM0800X | 00232032 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | 00232032 | CA | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.