Healthcare Provider Details

I. General information

NPI: 1790043891
Provider Name (Legal Business Name): VINCENT ELLIOTT SMITH LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22900 REMICK DR
CLINTON TWP MI
48036-2797
US

IV. Provider business mailing address

22900 REMICK DR
CLINTON TWP MI
48036-2797
US

V. Phone/Fax

Practice location:
  • Phone: 586-783-4802
  • Fax: 586-783-4805
Mailing address:
  • Phone: 586-783-4802
  • Fax: 586-783-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: