Healthcare Provider Details

I. General information

NPI: 1497479398
Provider Name (Legal Business Name): ANNISHIA SMITH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MADISON RD
CINCINNATI OH
45206
US

IV. Provider business mailing address

1435 VINE ST
CINCINNATI OH
45202-8005
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-5200
  • Fax: 513-354-7115
Mailing address:
  • Phone: 513-233-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2410704
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: