MEDICARE: RANDI E'LISE SMITH SUD COUNSELOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	162592	OH

General Provider Information

NPI Number	:	1447927637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI E'LISE SMITH SUD COUNSELOR

Provider Business Mailing Address
First Line	:	1251 YELLOWSTONE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1576
Country	:	US
Telephone Number	:	216-990-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 W MARKET ST STE 108
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7018
Country	:	US
Telephone Number	:	330-247-8277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	09/05/2024

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