Provider Demographics
NPI:1861769424
Name:SMITH, COLLEEN MARY (CADCII)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1998
Mailing Address - Country:US
Mailing Address - Phone:541-343-2993
Mailing Address - Fax:541-684-4162
Practice Address - Street 1:3580 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1998
Practice Address - Country:US
Practice Address - Phone:541-343-2996
Practice Address - Fax:541-684-4162
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-03-64101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health