Healthcare Provider Details

I. General information

NPI: 1477298222
Provider Name (Legal Business Name): MISS MIRANDA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6084 ELK RD
CANFIELD OH
44406-9730
US

IV. Provider business mailing address

6084 ELK RD
CANFIELD OH
44406-9730
US

V. Phone/Fax

Practice location:
  • Phone: 330-775-9553
  • Fax: 330-775-9553
Mailing address:
  • Phone: 330-775-9553
  • Fax: 330-775-9553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.185061
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: