Provider Demographics
NPI:1538404470
Name:SMITH, CASSANDRA LAUREN (MSW,CI)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:LAUREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW,CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 PLUMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2825
Mailing Address - Country:US
Mailing Address - Phone:512-825-5043
Mailing Address - Fax:
Practice Address - Street 1:10901 PLUMEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2825
Practice Address - Country:US
Practice Address - Phone:512-825-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16944101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)