Provider Demographics
NPI:1447927637
Name:SMITH, RANDI E'LISE (SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:E'LISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1576
Mailing Address - Country:US
Mailing Address - Phone:216-990-3020
Mailing Address - Fax:
Practice Address - Street 1:1815 W MARKET ST STE 108
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7018
Practice Address - Country:US
Practice Address - Phone:330-247-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162592101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)