Provider Demographics
NPI:1962117168
Name:SMITH, STAINTON GRAHAM (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:STAINTON
Middle Name:GRAHAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 3RD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2763
Mailing Address - Country:US
Mailing Address - Phone:480-747-2532
Mailing Address - Fax:
Practice Address - Street 1:1480 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2084
Practice Address - Country:US
Practice Address - Phone:415-456-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT1301302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist