Provider Demographics
NPI:1679183560
Name:SMITH, MARY JEAN (CADCI)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2105 CAPURRO WAY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-499-5534
Mailing Address - Fax:775-499-5535
Practice Address - Street 1:2105 CAPURRO WAY STE 270
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8518
Practice Address - Country:US
Practice Address - Phone:775-499-5534
Practice Address - Fax:775-499-5535
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)