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Individual
DOREEN ROUSSEAU SMITH
Active
Individual
DOREEN ROUSSEAU SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC LIC PROF COUNS
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
000109
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000109
PROFESSIONAL LICENSE
CT
Enumeration date
09/20/2006
Last updated
08/13/2007
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