Provider Demographics
NPI:1649929621
Name:SMITH, CONSTANCE (WORKING ON MY LPC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:WORKING ON MY LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12956 MONACO WAY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9192
Mailing Address - Country:US
Mailing Address - Phone:303-638-1036
Mailing Address - Fax:
Practice Address - Street 1:12956 MONACO WAY
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9192
Practice Address - Country:US
Practice Address - Phone:303-638-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health