Healthcare Provider Details

I. General information

NPI: 1578138160
Provider Name (Legal Business Name): REBECCA ALICE SMITH LPCC, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 N HIGH ST STE 350
COLUMBUS OH
43235-8446
US

IV. Provider business mailing address

8492 SLAGLE RD
WINDHAM OH
44288-9767
US

V. Phone/Fax

Practice location:
  • Phone: 330-842-7486
  • Fax:
Mailing address:
  • Phone: 330-993-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607334
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: