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General NPI Number Information
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NPI Number | 1912693599
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Entity Type | Individual
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Provider Name | HEATHER C SMALLEY CADAC II
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Gender | Female
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 3282 MALLARD COVE LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-2883
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Country | US
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Telephone | 812-200-2789
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Fax |
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Provider Business Mailing Address
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Address Line | 9821 CRYSTAL COVE CT
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City | NEW HAVEN
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State | IN
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Zip | 46774-2803
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Country | US
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Telephone | 260-310-9086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C2-51331
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License Number State | IN
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