Healthcare Provider Details

I. General information

NPI: 1619814282
Provider Name (Legal Business Name): SHANNON P SMITH LSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 STATE ROUTE 34 STE 202
COLTS NECK NJ
07722-2439
US

IV. Provider business mailing address

1761 RALEIGH CT W APT 79B
OCEAN NJ
07712-2639
US

V. Phone/Fax

Practice location:
  • Phone: 732-852-7879
  • Fax:
Mailing address:
  • Phone: 516-469-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00418900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: