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General NPI Number Information
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NPI Number | 1104219823
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Entity Type | Individual
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Provider Name | MRS. LUCINDA SMITH
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 3200 GREENFIELD RD STE 300
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City | DEARBORN
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State | MI
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Zip | 48120-1805
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Country | US
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Telephone | 313-318-8208
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Fax | 313-349-5960
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Provider Business Mailing Address
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Address Line | PO BOX 442563
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City | DETROIT
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State | MI
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Zip | 48244-2563
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Country | US
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Telephone | 313-318-8208
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Fax | 313-349-5960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801082724
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License Number State | MI
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