Individual
MELISSA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, MHP
Contact information
Practice address
300 RED BUD LN, VIENNA, IL 62995-1792
(618) 658-3079
Mailing address
300 RED BUD LN, VIENNA, IL 62995-1792
(618) 658-3079
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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