Provider Demographics
NPI:1891668422
Name:SMITH- BROWN, DESTINY (PPSC)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:SMITH- BROWN
Suffix:
Gender:F
Credentials:PPSC
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PPSC
Mailing Address - Street 1:210 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3246
Mailing Address - Country:US
Mailing Address - Phone:510-748-4023
Mailing Address - Fax:
Practice Address - Street 1:210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3246
Practice Address - Country:US
Practice Address - Phone:510-748-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240064278101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool