Provider Demographics
NPI:1417600669
Name:SMITH-HENRY, EDIE M
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:M
Last Name:SMITH-HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MARKET ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2624
Mailing Address - Country:US
Mailing Address - Phone:330-330-8332
Mailing Address - Fax:330-330-8332
Practice Address - Street 1:5500 MARKET ST STE 203
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2624
Practice Address - Country:US
Practice Address - Phone:330-330-8332
Practice Address - Fax:330-330-8332
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)