MEDICARE: GREG SMITH CDCA

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

General Provider Information

NPI Number	:	1811490014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG SMITH CDCA

Provider Business Mailing Address
First Line	:	1649 BRICE RD STE C
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-2796
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 S HAMILTON RD STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4317
Country	:	US
Telephone Number	:	855-519-2787
Fax Number	:	614-868-1690

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	11/12/2020

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