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NPI Code Detail

MEDICARE: EMACULETE SMITH CDCA

MEDICARE: EMACULETE 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
1171M00000XCase Manager/Care CoordinatorOH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA161690OH

General Provider Information

NPI Number : 1457896854
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMACULETE SMITH CDCA
Provider Business Mailing Address
First Line : 1007 N UNION ST
Second Line :
City : LIMA
State : OH
Zip : 45801-2942
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 : 937-387-6395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2016
Last Update Date : 07/12/2023

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