Provider Demographics
NPI:1316166077
Name:SMITH, DIANI
Entity type:Individual
Prefix:MS
First Name:DIANI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VICTOR AVE
Mailing Address - Street 2:APT. #108
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2640
Mailing Address - Country:US
Mailing Address - Phone:310-400-4339
Mailing Address - Fax:
Practice Address - Street 1:2118 S. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:213-493-4664
Practice Address - Fax:213-537-0110
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor