Provider Demographics
NPI:1407678014
Name:SMITH, NICACIA CAROL (HSD)
Entity type:Individual
Prefix:
First Name:NICACIA
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:HSD
Other - Prefix:
Other - First Name:NICACIA
Other - Middle Name:CAROL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HSD
Mailing Address - Street 1:18610 SE MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5531
Mailing Address - Country:US
Mailing Address - Phone:971-317-6037
Mailing Address - Fax:971-925-8605
Practice Address - Street 1:1200 CONCORD AVE STE 185
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5006
Practice Address - Country:US
Practice Address - Phone:971-317-6037
Practice Address - Fax:971-925-8605
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician