Individual
SALLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
4525 SOUTHCREEK RD, MOORE, OK 73165-7359
(405) 226-7473
Mailing address
4525 SOUTHCREEK RD, MOORE, OK 73165-7359
(405) 226-7473
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
207
OK
Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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