Provider Demographics
NPI:1588091235
Name:SMITH, LINA (LBSW, ADC)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LBSW, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4116
Mailing Address - Country:US
Mailing Address - Phone:208-376-7083
Mailing Address - Fax:208-402-5604
Practice Address - Street 1:709 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4116
Practice Address - Country:US
Practice Address - Phone:208-376-7083
Practice Address - Fax:208-402-5604
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-28715104100000X
ID11540033101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker