MEDICARE: AMANDA DAWN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401225207	MI

General Provider Information

NPI Number	:	1205107455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DAWN SMITH

Provider Business Mailing Address
First Line	:	2950 W HOWELL RD
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-9329
Country	:	US
Telephone Number	:	517-367-0670
Fax Number	:	517-367-0681

Provider Business Practice Location Address
First Line	:	29000 INKSTER RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-1097
Country	:	US
Telephone Number	:	517-367-0670
Fax Number	:	517-367-0681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	04/21/2026

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Directions to “ AMANDA DAWN SMITH ” Practice Location

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