Provider Demographics
NPI:1689410284
Name:SMITH, SARA JOANN (AAC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JOANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2233
Mailing Address - Country:US
Mailing Address - Phone:360-546-1722
Mailing Address - Fax:
Practice Address - Street 1:317 E 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2233
Practice Address - Country:US
Practice Address - Phone:360-546-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61573622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health