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General NPI Number Information
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NPI Number | 1629802079
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Entity Type | Individual
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Provider Name | EDNA KATHALEEN SMITH CAC-AD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 4201 PRIMROSE AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-3305
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Country | US
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Telephone | 410-764-8560
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Fax | 410-764-9114
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Provider Business Mailing Address
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Address Line | 10 MONTROSE AVE
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4132
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Country | US
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Telephone | 443-722-6760
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC2022
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License Number State | MD
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