Basic Information
| Provider Information | |||||||||
| NPI: | 1083758692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LESLIE | ||||||||
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| Credential: | D.MIN. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BETHEL RD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145380353 | ||||||||
| FaxNumber: | 6145861879 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 BETHEL RD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145380353 | ||||||||
| FaxNumber: | 6145861879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 923214 | OH | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP1600X | 3423 | X | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YP2500X | E0003157 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.