Individual
BRIAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Mailing address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.140897
OH
324500000X
Substance Abuse Rehabilitation Facility
Primary
140897
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2374229
—
OH
Enumeration date
09/16/2014
Last updated
02/28/2018
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