Provider Demographics
NPI:1043488018
Name:SMITH CANNADY COUNSELING ASSOCIATES INC
Entity Type:Organization
Organization Name:SMITH CANNADY COUNSELING ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONTRESSIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH-CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-569-4290
Mailing Address - Street 1:15659 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2188
Mailing Address - Country:US
Mailing Address - Phone:248-569-4290
Mailing Address - Fax:248-569-0609
Practice Address - Street 1:15659 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2188
Practice Address - Country:US
Practice Address - Phone:248-569-4290
Practice Address - Fax:248-569-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010014881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8008904140OtherBCBSM
8008904140OtherBCBSM