Provider Demographics
NPI:1467471904
Name:SMITH, DAVID C (LISW, LICDC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 403
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3401
Mailing Address - Country:US
Mailing Address - Phone:866-466-9591
Mailing Address - Fax:440-772-1010
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:SUITE 365
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3437
Practice Address - Country:US
Practice Address - Phone:866-466-9591
Practice Address - Fax:888-521-1811
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981337101YA0400X
OHI-00083991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP05277Medicare UPIN