Provider Demographics
NPI:1629271325
Name:SMITH-RATLIFF, JACQUELINE ALICE (LMFT)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ALICE
Last Name:SMITH-RATLIFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:ALICE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 3665
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-0665
Mailing Address - Country:US
Mailing Address - Phone:510-258-8869
Mailing Address - Fax:800-858-8673
Practice Address - Street 1:7273 MURRAY DR STE 12
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3390
Practice Address - Country:US
Practice Address - Phone:510-816-1265
Practice Address - Fax:800-858-8673
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF47159106H00000X
CA48253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist