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Individual
MRS. LISA SMITH
Active
Individual
MRS. LISA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICDC, SAP, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
111024
OH
101YP2500X
Professional Counselor
C.2003026
OH
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
405300000X
Prevention Professional
OCPC.1222
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0206488
—
OH
Enumeration date
05/19/2015
Last updated
11/23/2020
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