Healthcare Provider Details

I. General information

NPI: 1871655209
Provider Name (Legal Business Name): CRAIG SMITH LADC, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/03/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITALITY DRIVE
BERLIN VT
05601-0560
US

IV. Provider business mailing address

PO BOX 487
BROOKFIELD VT
05036-0487
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-4156
  • Fax:
Mailing address:
  • Phone: 802-276-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000331
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0062986
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: