Basic Information
| Provider Information | |||||||||
| NPI: | 1104033760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6322 HORIZON WAY | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471118899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129877253 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7509 CHARLESTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122564686 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.