Provider Demographics
NPI:1124586169
Name:ACOSTA-SMITH, LINDA DORRAINE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DORRAINE
Last Name:ACOSTA-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 GRANITE POINT TRL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1100
Mailing Address - Country:US
Mailing Address - Phone:409-466-4877
Mailing Address - Fax:
Practice Address - Street 1:609 GRANITE POINT TRL SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1100
Practice Address - Country:US
Practice Address - Phone:409-466-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0183791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional