Healthcare Provider Details

I. General information

NPI: 1104033760
Provider Name (Legal Business Name): CASSANDRA SMITH MS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 CHARLESTOWN PIKE
CHARLESTOWN IN
47111-9623
US

IV. Provider business mailing address

6322 HORIZON WAY
CHARLESTOWN IN
47111-8899
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-4686
  • Fax:
Mailing address:
  • Phone: 812-987-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: