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General NPI Number Information
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NPI Number | 1528402278
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Entity Type | Organization
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Legal Business Name | GARY G SMITH, LMSW, LLC
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 1945 PAULINE BLVD SUITE 14
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City | ANN ARBOR
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State | MI
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Zip | 48103-5047
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Country | US
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Telephone | 734-646-3581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3365
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City | ANN ARBOR
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State | MI
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Zip | 48106-3365
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Country | US
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Telephone | 734-646-3581
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/THERAPIST
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Name | GARY G SMITH
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Credential | LMSW
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Telephone | 734-646-3581
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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 | 6801088994
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License Number State | MI
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