Individual
CHRISTINA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CD
Contact information
Practice address
2086 RIDGEWAY DR, GRAND RAPIDS, MN 55744-4421
(218) 327-9944
Mailing address
2086 RIDGEWAY DR, GRAND RAPIDS, MN 55744-4421
(218) 327-9944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301636
STATE LICENSE
MN
Enumeration date
05/05/2010
Last updated
05/05/2010
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