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General NPI Number Information
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NPI Number | 1831721273
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Entity Type | Individual
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Provider Name | TABITHA CHARLENE SMITH LPN, CDCA, QBHS
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Gender | Female
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 1012 ODNR MOHICAN 51
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City | PERRYSVILLE
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State | OH
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Zip | 44864-9407
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Country | US
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Telephone | 419-994-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 213 E CHESTNUT ST
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3404
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Country | US
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Telephone | 740-326-9255
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA178300
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN.111823.MEDS
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License Number State | OH
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