Provider Demographics
NPI:1285258277
Name:SMITH, QUINDA C (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:QUINDA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 BROADMOOR VALLEY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4471
Mailing Address - Country:US
Mailing Address - Phone:719-301-7731
Mailing Address - Fax:
Practice Address - Street 1:2993 BROADMOOR VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4471
Practice Address - Country:US
Practice Address - Phone:719-640-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099271141041C0700X
COLSW.0009922474104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker