Provider Demographics
NPI:1992062707
Name:SMILEY, CAROLYN A (PCC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:A
Last Name:SMILEY
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6693 NORTH CHESTNUT ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266
Mailing Address - Country:US
Mailing Address - Phone:330-296-3700
Mailing Address - Fax:330-298-1460
Practice Address - Street 1:6693 NORTH CHESTNUT ST
Practice Address - Street 2:SUITE 235
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266
Practice Address - Country:US
Practice Address - Phone:330-296-3700
Practice Address - Fax:330-298-1460
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900401101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor