Healthcare Provider Details

I. General information

NPI: 1205421989
Provider Name (Legal Business Name): MARTHA MARIE SMITT LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 N CANAL RD
DIMONDALE MI
48821-8742
US

IV. Provider business mailing address

5265 N CANAL RD
DIMONDALE MI
48821-8742
US

V. Phone/Fax

Practice location:
  • Phone: 248-820-6601
  • Fax:
Mailing address:
  • Phone: 248-820-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: