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General NPI Number Information
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NPI Number | 1316795834
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Entity Type | Individual
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Provider Name | MR. L'CHRISTIAN SHANE SMITH-COCHRAN
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Gender | Male
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Dates
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Enumeration Date | 05/09/2024
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 4130 LINDEN AVE
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City | DAYTON
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State | OH
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Zip | 45432-3015
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Country | US
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Telephone | 216-394-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 4246 VITEK DR
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City | DAYTON
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State | OH
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Zip | 45424-5705
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Country | US
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Telephone | 937-321-7195
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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