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NPI Code Detail

MEDICARE: MISTY A SMITH CDCA

MEDICARE: MISTY A 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 CoordinatorCDCA.169911OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.169911OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841787496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY A SMITH CDCA
Provider Business Mailing Address
First Line : 517 3RD AVE
Second Line :
City : CHESAPEAKE
State : OH
Zip : 45619-1036
Country : US
Telephone Number : 740-451-1455
Fax Number : 740-451-1455
Provider Business Practice Location Address
First Line : 517 3RD AVE
Second Line :
City : CHESAPEAKE
State : OH
Zip : 45619-1036
Country : US
Telephone Number : 740-451-1455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 02/19/2024

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Directions to “ MISTY A SMITH CDCA” Practice Location

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