Provider Demographics
NPI:1386368397
Name:SMOLARZ, GREG JOSEPH II (SUDPT)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:JOSEPH
Last Name:SMOLARZ
Suffix:II
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24823 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5478
Mailing Address - Country:US
Mailing Address - Phone:253-681-0100
Mailing Address - Fax:
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:206-605-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61358694229N00000X, 221700000X
390200000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist