Provider Demographics
NPI:1093244485
Name:SMITH, MARISSA VIOLA (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:VIOLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 W 120TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3493
Mailing Address - Country:US
Mailing Address - Phone:720-319-7468
Mailing Address - Fax:
Practice Address - Street 1:11001 W 120TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3493
Practice Address - Country:US
Practice Address - Phone:720-319-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
COLPC.0014671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)