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NPI Code Detail

MEDICARE: MRS. LYNDA LOUISE SMITH FAODP, MA, MDIV

MEDICARE: MRS. LYNDA LOUISE SMITH FAODP, MA, MDIV
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1811027113
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNDA LOUISE SMITH FAODP, MA, MDIV
Provider Business Mailing Address
First Line : 1703 ORLEANS ST
Second Line :
City : DETROIT
State : MI
Zip : 48207-2771
Country : US
Telephone Number : 313-617-4615
Fax Number :
Provider Business Practice Location Address
First Line : 5470 CHENE ST
Second Line : SUITE 100
City : DETROIT
State : MI
Zip : 48211-2746
Country : US
Telephone Number : 313-875-5521
Fax Number : 313-267-0549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/08/2007

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