Provider Demographics
NPI:1649220716
Name:SMITH, CASSANDRA DIAN (MSW, GSW)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:DIAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5960
Mailing Address - Country:US
Mailing Address - Phone:318-251-4150
Mailing Address - Fax:318-251-4177
Practice Address - Street 1:901 WHITE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5960
Practice Address - Country:US
Practice Address - Phone:318-251-4150
Practice Address - Fax:318-251-4177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGSW CERTIFICATE#5251104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker