Healthcare Provider Details

I. General information

NPI: 1811027113
Provider Name (Legal Business Name): LYNDA LOUISE SMITH FAODP, MA, MDIV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 CHENE ST SUITE 100
DETROIT MI
48211-2746
US

IV. Provider business mailing address

1703 ORLEANS ST
DETROIT MI
48207-2771
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-5521
  • Fax: 313-267-0549
Mailing address:
  • Phone: 313-617-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: