Individual
ALYCIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 NE ROBERTS AVE STE 200, GRESHAM, OR 97030-7484
(971) 220-2496
Mailing address
4233 SE 182ND AVE # 212, GRESHAM, OR 97030-5082
(971) 220-2496
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CG60615744
WA
1041C0700X
Clinical Social Worker
Primary
L7466
OR
1041C0700X
Clinical Social Worker
LW60824262
WA
Other
Enumeration date
12/31/2015
Last updated
11/29/2022
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