Healthcare Provider Details

I. General information

NPI: 1942065016
Provider Name (Legal Business Name): MRS. ALICIA SHARAIM SMILEY-FULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E BIG BEAVER RD
TROY MI
48083-1905
US

IV. Provider business mailing address

34020 CHARLOTTE DR
STERLING HEIGHTS MI
48312-5760
US

V. Phone/Fax

Practice location:
  • Phone: 248-524-8801
  • Fax: 248-524-8850
Mailing address:
  • Phone: 586-804-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852088181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: