Provider Demographics
NPI:1881850162
Name:SMITH, TAMARA J (PCC, LLC)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PCC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 DELTA AVE.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208
Mailing Address - Country:US
Mailing Address - Phone:513-255-0474
Mailing Address - Fax:
Practice Address - Street 1:1015 DELTA AVE.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208
Practice Address - Country:US
Practice Address - Phone:513-255-0474
Practice Address - Fax:513-229-0202
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0004075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional