Shannon Devaughn Smith

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

000332976 Issued in OH

Practice address

17400 Northwood Ave
Lakewood, OH 44107-2210

Phone

(216) 403-8640

NPI assigned

May 6, 2020

Last updated

May 6, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Old School LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Lakewood, OH
  • NPI 1215329909
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1326669888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17400 NORTHWOOD AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441072210",
            "telephone_number": "216-403-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17400 NORTHWOOD AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441072210",
            "telephone_number": "216-403-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNON",
        "middle_name": "DEVAUGHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-06",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "000332976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APP-000332976",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.oldschool.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "17400 Northwood Ave",
            "city": "Lakewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441072210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.oldschoolrecovery.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "17400 Northwood Ave",
            "city": "Lakewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441072210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.oldschoolrecovery.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "17400 Northwood Ave",
            "city": "Lakewood",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441072210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kendall Smith, QMHS
• Matthew J Smith, D.D.S.
• Melissa Smith, M.S. CCC-SLP
• Nikita S Smith, RN
• Rhonda C Smith
• Snowfall Sessions Counseling & Wellness
• Jennifer L Snyder
• Sophia K. Fotinos O.D., LLC
• Chelsea Lyn Sousa, PSY.D.
• Erin Spangler, MA, PC

• Addiction (Substance Use Disorder) Counselor in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.