Carressa Ann Smith, LPCC, LICDC

Individual provider Active NPI Counselor · Crescent Springs, KY

NPI 1891004487 · NPPES record last updated Jan 3, 2019

Key facts

NPI
1891004487
Entity type
Individual (NPI type 1)
Primary specialty
Counselor 101Y00000X
License
C0900048 (OH)
Practice address
541 Buttermilk Pike Ste 105
Crescent Springs, KY 41017
Phone
(513) 477-3111
Fax
(859) 485-8594
NPI assigned
Sep 29, 2010
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
C0900048OHMDCounselor
071020OHMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 071020 OH
Counselor 101Y00000X C0900048 OH Yes

Addresses

Primary practice location

541 Buttermilk Pike Ste 105
Crescent Springs, KY 41017

Mailing address

3515 Werk Rd
Cincinnati, OH 45248-6229
Phone (513) 477-3111

Other practice location 1

3515 Werk Rd
Cincinnati, OH 45248-6229
Phone (513) 477-3111

Other identifiers

IdentifierTypeStateIssuer
1252273OtherOHCAQH

Other providers in Crescent Springs, KY

All providers in Crescent Springs, KY · Counselor in Kentucky

Sources for this page

Verify at the official NPI Registry.