Healthcare Provider Details

I. General information

NPI: 1144022765
Provider Name (Legal Business Name): NATHANIEL DAVID SMITH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ANN ST NW
GRAND RAPIDS MI
49505-6247
US

IV. Provider business mailing address

7 ANN ST NW
GRAND RAPIDS MI
49505-6247
US

V. Phone/Fax

Practice location:
  • Phone: 616-706-3319
  • Fax:
Mailing address:
  • Phone: 616-706-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801111209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: