Healthcare Provider Details

I. General information

NPI: 1881163988
Provider Name (Legal Business Name): BRANDON SCOTT SMITH CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 MONROE ST
TOLEDO OH
43623-4307
US

IV. Provider business mailing address

2823 CHERRY ST
TOLEDO OH
43608-1713
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-5709
  • Fax:
Mailing address:
  • Phone: 419-860-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168631
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: