1629425699 NPI number — MS. YALANDA L SMITH-HUDLIN LPCC, LCDC III

Table of content: MS. YALANDA L SMITH-HUDLIN LPCC, LCDC III (NPI 1629425699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629425699 NPI number — MS. YALANDA L SMITH-HUDLIN LPCC, LCDC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH-HUDLIN
Provider First Name:
YALANDA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC, LCDC III
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629425699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HIGH ST FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45011-6078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-454-1460
Provider Business Mailing Address Fax Number:
937-641-6129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 E. EDWIN C. MOSES BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-535-5060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LDCDIII.101080 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: E.1700224 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E.1700224 . This is a "COUNSELOR, SOCIAL WORKER, & MFT BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: LCDCIII.101080 . This is a "OHIO CHEMICAL DEPENDENCY PROFESSIONALS BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0429235 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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