Provider Demographics
NPI:1760686786
Name:SMITH, NANCY A (MSWLCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSWLCSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1323 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3301
Mailing Address - Country:US
Mailing Address - Phone:171-964-9752
Mailing Address - Fax:
Practice Address - Street 1:3230 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8501
Practice Address - Country:US
Practice Address - Phone:719-623-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19861041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical