Provider Demographics
NPI:1013791144
Name:SMITH, CHARLES KALUB (QBHS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KALUB
Last Name:SMITH
Suffix:
Gender:M
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1143
Mailing Address - Country:US
Mailing Address - Phone:937-544-5547
Mailing Address - Fax:937-544-3035
Practice Address - Street 1:923 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1143
Practice Address - Country:US
Practice Address - Phone:937-544-5547
Practice Address - Fax:937-544-3035
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQBHS101YM0800X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management