MEDICARE: SHANTA NATRE SMITH MS, LLBSW, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6802086480	MI

General Provider Information

NPI Number	:	1861837502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTA NATRE SMITH MS, LLBSW, CADC

Provider Business Mailing Address
First Line	:	4207 WHISPERING OAK DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-5541
Country	:	US
Telephone Number	:	810-308-8792
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 MARTIN LUTHER KING BLVD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-232-5641
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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