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General NPI Number Information
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NPI Number | 1205756244
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Entity Type | Individual
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Provider Name | JEREMYAH N SMITH CADC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 300 TUSKEGEE BLVD
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City | DOVER AFB
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State | DE
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Zip | 19902-5003
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Country | US
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Telephone | 302-730-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 301 KEARSNEY CT UNIT A6
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City | DOVER
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State | DE
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Zip | 19901-4246
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Country | US
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Telephone | 757-663-1710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2925
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License Number State | DE
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