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Individual
JACKIE SMITH JR.
Active
Individual
JACKIE SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070726
MASTER PROVIDER NUMBER
CA
01
—
070753
MASTER PROVIDER FILE NUMB
CA
01
—
0726
DRUG M/CAL BILLING NUMBER
CA
01
—
0753
DRUG MEDI-CAL BILLING NO
CA
01
—
07553
BRENTWOOD ADOL TX
CA
01
—
07557
DMC ADOL BRENTWOOD
CA
01
—
56681
STAFF ID NUMBER
CA
Enumeration date
05/03/2007
Last updated
02/05/2008
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