Provider Demographics
NPI:1891004487
Name:SMITH, CARRESSA ANN (LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:CARRESSA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 WERK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-6229
Mailing Address - Country:US
Mailing Address - Phone:513-477-3111
Mailing Address - Fax:
Practice Address - Street 1:541 BUTTERMILK PIKE STE 105
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:513-477-3111
Practice Address - Fax:859-485-8594
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH071020101YA0400X
OHC0900048101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1252273OtherCAQH