Healthcare Provider Details

I. General information

NPI: 1821754110
Provider Name (Legal Business Name): REBECCA LEE SMITH CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 INDIAN WOOD CIR
MAUMEE OH
43537-4009
US

IV. Provider business mailing address

10019 REISTERSTOWN RD FL 3
OWINGS MILLS MD
21117-3902
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-1814
  • Fax: 419-318-1603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.178854
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: