Healthcare Provider Details

I. General information

NPI: 1396650412
Provider Name (Legal Business Name): ALYSSA-MICHELLE GODDESS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18249 HUNTLEY SQ N
BEVERLY HILLS MI
48025-5321
US

IV. Provider business mailing address

18249 HUNTLEY SQ N
BEVERLY HILLS MI
48025-5321
US

V. Phone/Fax

Practice location:
  • Phone: 424-645-2419
  • Fax:
Mailing address:
  • Phone: 424-645-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: