Basic Information
| Provider Information | |||||||||
| NPI: | 1740311265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPCC, LICDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374926970 | ||||||||
| FaxNumber: | 9374926971 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374926970 | ||||||||
| FaxNumber: | 9374926971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 991481 | OH | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | E 3384 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.