Provider Demographics
NPI:1902779010
Name:SMITH, MARIA LETICIA (MA ED, APCC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LETICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA ED, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 SISK RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9445
Mailing Address - Country:US
Mailing Address - Phone:209-543-3133
Mailing Address - Fax:
Practice Address - Street 1:4801 SISK RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9445
Practice Address - Country:US
Practice Address - Phone:209-543-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC10140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health