Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 27912 | CA |
NPI | 1225581804 |
---|---|
Provider Name | Dr. Shelby Karoline Smith |
First Address | Walnut Creek, CA 94596-5229 |
Second Address | Walnut Creek, CA 94596-5229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2016 |
Last Update Date | 11/02/2022 |