Provider Demographics
NPI:1265857833
Name:SMITH, STEVANIE E (MED, LCADC)
Entity Type:Individual
Prefix:MS
First Name:STEVANIE
Middle Name:E
Last Name:SMITH
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Gender:F
Credentials:MED, LCADC
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Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:1001
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2282
Mailing Address - Country:US
Mailing Address - Phone:859-687-0416
Mailing Address - Fax:859-353-4200
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:1001
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2282
Practice Address - Country:US
Practice Address - Phone:859-687-0416
Practice Address - Fax:859-353-4200
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY171070101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12669382OtherCAQH
KY7100294500Medicaid