Healthcare Provider Details

I. General information

NPI: 1518457175
Provider Name (Legal Business Name): SHANNON HOFF-SMITH LISW LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W PARK DR
LORAIN OH
44053
US

IV. Provider business mailing address

2115 W PARK DR
LORAIN OH
44053-1138
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161994
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: