Provider Demographics
NPI:1306402318
Name:SMITH, CHRISTINA MARIA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-6956
Mailing Address - Country:US
Mailing Address - Phone:419-242-9955
Mailing Address - Fax:419-242-8855
Practice Address - Street 1:701 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6956
Practice Address - Country:US
Practice Address - Phone:419-242-9955
Practice Address - Fax:419-242-8855
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18021611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1802161OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER & MARRIAGE AND FAMILY THERAPIST BOARD