Provider Demographics
NPI:1508577693
Name:SMITH, CANDRA N (PLPC)
Entity Type:Individual
Prefix:
First Name:CANDRA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:CANDRA
Other - Middle Name:N
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:2012 CHERRY HILL DR STE 102B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5882
Mailing Address - Country:US
Mailing Address - Phone:573-891-1330
Mailing Address - Fax:
Practice Address - Street 1:2012 CHERRY HILL DR STE 102B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5882
Practice Address - Country:US
Practice Address - Phone:573-891-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor