Provider Demographics
NPI:1386270221
Name:SMITH, DANTHONY T
Entity type:Individual
Prefix:
First Name:DANTHONY
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 NE 2ND ST UNIT 1214
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5333
Mailing Address - Country:US
Mailing Address - Phone:337-718-9505
Mailing Address - Fax:
Practice Address - Street 1:10608 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5157
Practice Address - Country:US
Practice Address - Phone:337-718-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health