Healthcare Provider Details

I. General information

NPI: 1538582192
Provider Name (Legal Business Name): EFRION SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28755 SCHOENHERR RD SUITE 100
WARREN MI
48088-4395
US

IV. Provider business mailing address

28755 SCHOENHERR RD SUITE 100
WARREN MI
48088-4395
US

V. Phone/Fax

Practice location:
  • Phone: 586-920-2546
  • Fax: 586-920-2200
Mailing address:
  • Phone: 586-920-2546
  • Fax: 586-920-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080986
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: