Edna Kathaleen Smith, CAC-AD

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

AC2022 Issued in MD

Practice address

4201 Primrose Ave
Baltimore, MD 21215-3305

Phone

(410) 764-8560

Fax

(410) 764-9114

NPI assigned

Aug 28, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1629802079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MONTROSE AVE",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174132",
            "telephone_number": "443-722-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 PRIMROSE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212153305",
            "telephone_number": "410-764-8560",
            "fax_number": "410-764-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "EDNA",
        "middle_name": "KATHALEEN",
        "credential": "CAC-AD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "AC2022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Michael Smith, MD FCCP
• Desaray Smith, LCSW-C
• Destinee Deasia Smith
• Donna R Smith, LCPC
• Duwayne F Smith
• Elana Smith, MD
• Elijah Smith
• Elizabeth Smith
• Elizabeth Horne Smith, MSW, LCSW-C
• Elysia Smith

• Addiction (Substance Use Disorder) Counselor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Addiction (Substance Use Disorder) Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.