Provider Demographics
NPI:1700035045
Name:SMITH, NANCY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NIKKA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1616 W MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1146
Mailing Address - Country:US
Mailing Address - Phone:618-889-9477
Mailing Address - Fax:618-997-5997
Practice Address - Street 1:1616 W MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1146
Practice Address - Country:US
Practice Address - Phone:618-889-9477
Practice Address - Fax:618-997-5997
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490044171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical