MEDICARE: MR. RICK C SMITH LCDC III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA168836	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.161870	OH
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.162714	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCDCII.161870	OTHER	OH	OHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD
2	LCDCIII.162714	OTHER	OH	OHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD
3	CDCA168836	OTHER	OH	OHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD

General Provider Information

NPI Number	:	1205307626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICK C SMITH LCDC III

Provider Business Mailing Address
First Line	:	712 CEDAR DR APT 8
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-4871
Country	:	US
Telephone Number	:	937-343-1788
Fax Number	:	937-343-1788

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-813-1737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	04/07/2026

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Directions to “ MR. RICK C SMITH LCDC III” Practice Location

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