Provider Demographics
NPI:1366569469
Name:SMITH, ALINE (MFT)
Entity type:Individual
Prefix:DR
First Name:ALINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-0372
Mailing Address - Country:US
Mailing Address - Phone:310-644-3300
Mailing Address - Fax:310-872-5505
Practice Address - Street 1:8621 BELLANCA AVE STE 215
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4432
Practice Address - Country:US
Practice Address - Phone:310-641-1633
Practice Address - Fax:310-216-7524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22617101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366569469Medicaid