Provider Demographics
NPI:1144091976
Name:SMITH-WELLS, CONNIE AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:AMANDA
Last Name:SMITH-WELLS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8237
Mailing Address - Country:US
Mailing Address - Phone:702-326-6757
Mailing Address - Fax:
Practice Address - Street 1:425 2ND AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2483
Practice Address - Country:US
Practice Address - Phone:541-286-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health