Individual
MRS. DIANA MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC-MH
Contact information
Practice address
6613 EASTRIDGE RD, BLACK HAWK, SD 57718-8335
(605) 431-8595
(605) 431-8595
Mailing address
6613 EASTRIDGE RD, BLACK HAWK, SD 57718-8335
(605) 347-7560
(605) 718-7595
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC MH 2025
SD
101YM0800X
Mental Health Counselor
Primary
LPC MH 2025
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4997637
DAKOTA CARE
SD
05
—
6575393
—
SD
Enumeration date
01/18/2007
Last updated
02/07/2020
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