Provider Demographics
NPI:1679559504
Name:SMITH, MICHAEL DIMOCK II (LMHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DIMOCK
Last Name:SMITH
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST SUITE C1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-752-1860
Mailing Address - Fax:253-752-1890
Practice Address - Street 1:1919 N PEARL ST SUITE C1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-752-1860
Practice Address - Fax:253-752-1890
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
7406504OtherBLUE CROSS BLUE SHIELD