Provider Demographics
NPI:1801196555
Name:SMITH, STEPHEN J (LICDC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD # C
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6402
Mailing Address - Country:US
Mailing Address - Phone:440-460-0140
Mailing Address - Fax:440-460-5413
Practice Address - Street 1:6559 WILSON MILLS RD # C
Practice Address - Street 2:SUITE 102
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-460-0140
Practice Address - Fax:440-460-5413
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)