Basic Information
| Provider Information | |||||||||
| NPI: | 1134255011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 3RD ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955010554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074418626 | ||||||||
| FaxNumber: | 7072680218 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 3RD ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955010554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074418626 | ||||||||
| FaxNumber: | 7074425040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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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 | 1041C0700X | LCSW80139 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.