Provider Demographics
NPI:1467755215
Name:SMITH, ALISHA DIANE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:DIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1654
Mailing Address - Country:US
Mailing Address - Phone:319-434-6430
Mailing Address - Fax:
Practice Address - Street 1:3113 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4524
Practice Address - Country:US
Practice Address - Phone:319-361-6529
Practice Address - Fax:319-228-8776
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker