Healthcare Provider Details

I. General information

NPI: 1417744459
Provider Name (Legal Business Name): CRYSTAL SMITH LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 NEW MARKET CENTER WAY
COLUMBUS OH
43235-1976
US

IV. Provider business mailing address

4734 MICHAEL PL
GROVE CITY OH
43123-9460
US

V. Phone/Fax

Practice location:
  • Phone: 614-602-6473
  • Fax:
Mailing address:
  • Phone: 614-302-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181865
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: