Healthcare Provider Details

I. General information

NPI: 1184287864
Provider Name (Legal Business Name): TARA A SMITH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CORPORATE CT
OREFIELD PA
18069-3158
US

IV. Provider business mailing address

1289 FOREST RD
WHITEHALL PA
18052-6217
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0444
  • Fax:
Mailing address:
  • Phone: 484-505-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014224
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: