Provider Demographics
NPI:1003506577
Name:SMITH, DIANA SUE (LADC, MA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LADC, MA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:SUE
Other - Last Name:FINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC, MA
Mailing Address - Street 1:6800 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2758
Mailing Address - Country:US
Mailing Address - Phone:612-924-3807
Mailing Address - Fax:
Practice Address - Street 1:6800 78TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2758
Practice Address - Country:US
Practice Address - Phone:612-924-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)