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NPI Code Detail

MEDICARE: ANTONIO SMITH CDCA

MEDICARE: ANTONIO SMITH CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor194067OH

General Provider Information

NPI Number : 1376408716
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO SMITH CDCA
Provider Business Mailing Address
First Line : 137 ANNA ST
Second Line :
City : DAYTON
State : OH
Zip : 45417-2213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4977 NORTHCUTT PL
Second Line :
City : DAYTON
State : OH
Zip : 45414-3839
Country : US
Telephone Number : 800-829-5461
Fax Number : 800-829-5461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2025
Last Update Date : 12/18/2025

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Directions to “ ANTONIO SMITH CDCA” Practice Location

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