Healthcare Provider Details

I. General information

NPI: 1598177883
Provider Name (Legal Business Name): ELANA WILLIAMS-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 VINEWOOD ST
DETROIT MI
48208-1886
US

IV. Provider business mailing address

4707 VINEWOOD ST
DETROIT MI
48208-1886
US

V. Phone/Fax

Practice location:
  • Phone: 313-361-6135
  • Fax: 313-361-6211
Mailing address:
  • Phone: 313-361-6135
  • Fax: 313-361-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: