Healthcare Provider Details

I. General information

NPI: 1083475255
Provider Name (Legal Business Name): MAKANYA LATASHA SARVERA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIKKI L SMITH

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 W 52ND ST
CLEVELAND OH
44102-5817
US

IV. Provider business mailing address

3441 W 52ND ST
CLEVELAND OH
44102-5817
US

V. Phone/Fax

Practice location:
  • Phone: 216-799-9944
  • Fax:
Mailing address:
  • Phone: 216-799-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number178538
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2604988-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberFPS.000101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: