Provider Demographics
NPI:1043878481
Name:SMOLKIN, SHARON MICHELLE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MICHELLE
Last Name:SMOLKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33942 ARROWHEAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2719
Mailing Address - Country:US
Mailing Address - Phone:248-497-4716
Mailing Address - Fax:
Practice Address - Street 1:13973 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5403
Practice Address - Country:US
Practice Address - Phone:248-497-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-64955103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst