Provider Demographics
NPI:1629425699
Name:SMITH-HUDLIN, YALANDA L (LPCC, LCDC III)
Entity Type:Individual
Prefix:MS
First Name:YALANDA
Middle Name:L
Last Name:SMITH-HUDLIN
Suffix:
Gender:F
Credentials:LPCC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:165 E. EDWIN C. MOSES BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-535-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLDCDIII.101080101YA0400X
OHE.1700224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.1700224OtherCOUNSELOR, SOCIAL WORKER, & MFT BOARD
OHLCDCIII.101080OtherOHIO CHEMICAL DEPENDENCY PROFESSIONALS BOARD
OH0429235Medicaid