Provider Demographics
NPI:1083758692
Name:SMITH, JAMES LESLIE (DMIN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LESLIE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BETHEL RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2690
Mailing Address - Country:US
Mailing Address - Phone:614-538-0353
Mailing Address - Fax:614-586-1879
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:614-538-0353
Practice Address - Fax:614-586-1879
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923214101YA0400X
3423101YP1600X
OHE0003157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional