Provider Demographics
NPI:1831521442
Name:SMITH, JACQUELINE RENE (LPCC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTHLAND BLVD
Mailing Address - Street 2:SUITE 120B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3675
Mailing Address - Country:US
Mailing Address - Phone:513-703-4975
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD
Practice Address - Street 2:SUITE 120B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3675
Practice Address - Country:US
Practice Address - Phone:513-703-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0568101YM0800X
OHC.0006729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health