Individual
MRS. DIANE M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NBCC, CADC
Contact information
Practice address
7848 HIXON RD, MINOCQUA, WI 54548-9112
(920) 539-1160
Mailing address
7848 HIXON RD, MINOCQUA, WI 54548-9112
(920) 539-1160
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2746
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2746
LPC
WI
Enumeration date
05/09/2007
Last updated
07/08/2007
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