Provider Demographics
NPI:1205307626
Name:SMITH, RICK C (LCDC III)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CEDAR DR APT 8
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4871
Mailing Address - Country:US
Mailing Address - Phone:937-343-1788
Mailing Address - Fax:937-343-1788
Practice Address - Street 1:712 CEDAR DR APT 8
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4871
Practice Address - Country:US
Practice Address - Phone:937-343-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA168836101YA0400X
OHLCDCII.161870101YA0400X
OHLCDCIII.162714101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLCDCII.161870OtherOHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD
OHLCDCIII.162714OtherOHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD
OHCDCA168836OtherOHIO CHEMICAL DEPENDENCY PROFESSIONAL BOARD