Provider Demographics
NPI:1285525451
Name:SMITH, MONIQUE (MED, LPC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CUYAHOGA ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2123
Mailing Address - Country:US
Mailing Address - Phone:619-677-7483
Mailing Address - Fax:
Practice Address - Street 1:1608 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2109
Practice Address - Country:US
Practice Address - Phone:234-571-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2507164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health