| Doctor Name: | CONSTANCE SALLY SMITH |
| NPI Number: | 1063703221 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 302730 |
| Business Practice Address: | 1230 Eagan Industrial Rd Suite 100 Eagan, MN - 551211264 |
| Business Phone Number: | 6124542243 |
| Business Fax Number: | 6514542972 |
| Mailing Address: | 1230 Eagan Industrial Rd, Suite 100 EAGAN |
| State: | MN |
| Postal Code: | 551211264 |
| Phone Number: | 6124542243 |
| Fax Number: | 6514542972 |
| NPI Enumeration Date: | 04/22/2011 |
| NPI Last Update Date: | 04/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302730 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |