Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003210733 |
---|---|
Provider Name | Andrea L Smith |
First Address | Canton, MI 48188-1780 |
Second Address | Detroit, MI 48201-2599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 08/10/2014 |