Healthcare Provider Details

I. General information

NPI: 1427691666
Provider Name (Legal Business Name): MARION ANITA SMITH MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST # C PO BOX 249
PAW PAW MI
49079
US

IV. Provider business mailing address

61899M-43 PO BOX 179, VAN BURTEN COMMUNITY MENTAL HEALT
BANGER MI
49013
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-5574
  • Fax: 269-652-3474
Mailing address:
  • Phone: 269-427-5671
  • Fax: 269-427-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024363
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: