Provider Demographics
NPI:1174812580
Name:SMITH, LORI A (PCC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:STASKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:602 SOUTH ST
Mailing Address - Street 2:STE C1-A
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1499
Mailing Address - Country:US
Mailing Address - Phone:216-932-2800
Mailing Address - Fax:
Practice Address - Street 1:602 SOUTH ST
Practice Address - Street 2:STE C1-A
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1499
Practice Address - Country:US
Practice Address - Phone:216-932-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0600696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health