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NPI Code Detail

MEDICARE: CHRISTINA SMITH CD

MEDICARE: CHRISTINA SMITH CD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1301636OTHERMNSTATE LICENSE

General Provider Information

NPI Number : 1063730737
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA SMITH CD
Provider Business Mailing Address
First Line : 2086 RIDGEWAY DR
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-4421
Country : US
Telephone Number : 218-327-9944
Fax Number :
Provider Business Practice Location Address
First Line : 2086 RIDGEWAY DR
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-4421
Country : US
Telephone Number : 218-327-9944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2010
Last Update Date : 05/05/2010

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Directions to “ CHRISTINA SMITH CD” Practice Location

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