Provider Demographics
NPI:1366568255
Name:SMITH, AMELIA K (COUNSELOR)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 CHAPALA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3116
Mailing Address - Country:US
Mailing Address - Phone:805-450-4297
Mailing Address - Fax:
Practice Address - Street 1:1236 CHAPALA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3116
Practice Address - Country:US
Practice Address - Phone:805-450-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW696201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11250OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
11250OtherSFGH INTERNAL USE ONLY