Basic Information
| Provider Information | |||||||||
| NPI: | 1285019489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAZMANIKA | ||||||||
| MiddleName: | IKIAH MARIA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 ARLINGTON DR | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108464153 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4203 WOODCOCK DR STE 216 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782281312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105649116 | ||||||||
| FaxNumber: | 2105649087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 69263 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.