Provider Demographics
NPI:1528657780
Name:SMITH-CLINE, SARA MARIE (CO61126587)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:SMITH-CLINE
Suffix:
Gender:F
Credentials:CO61126587
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1209
Mailing Address - Country:US
Mailing Address - Phone:509-315-8682
Mailing Address - Fax:509-327-7816
Practice Address - Street 1:4324 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1209
Practice Address - Country:US
Practice Address - Phone:509-315-8682
Practice Address - Fax:509-327-7816
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61126587101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)