Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 923214 | OH |
N | 101YP1600X | Pastoral Counselor | 3423 | |
N | 101YP2500X | Professional Counselor | E0003157 | OH |
NPI | 1083758692 |
---|---|
Provider Name | James Leslie Smith |
First Address | Columbus, OH 43220-2690 |
Second Address | Columbus, OH 43220-2690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 09/07/2007 |