Provider Demographics
NPI:1598283350
Name:SMITH, TERIN KATHLENE (CDCA)
Entity Type:Individual
Prefix:
First Name:TERIN
Middle Name:KATHLENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 SMOKEY ROW RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-9030
Mailing Address - Country:US
Mailing Address - Phone:740-612-5040
Mailing Address - Fax:
Practice Address - Street 1:458 2ND AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1157
Practice Address - Country:US
Practice Address - Phone:740-446-2085
Practice Address - Fax:740-446-2292
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162277101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)