Provider Demographics
NPI:1205607751
Name:SMITH, ANDREW DOUGLAS (LPC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7254 CHATEAUROUX DR APT B
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5377
Mailing Address - Country:US
Mailing Address - Phone:828-450-4602
Mailing Address - Fax:
Practice Address - Street 1:28 E RAHN RD STE 217
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5461
Practice Address - Country:US
Practice Address - Phone:828-450-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health