Provider Demographics
NPI:1184182107
Name:BELL-SMITH, DEADRA YVONNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DEADRA
Middle Name:YVONNE
Last Name:BELL-SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3542
Mailing Address - Country:US
Mailing Address - Phone:313-680-3816
Mailing Address - Fax:
Practice Address - Street 1:14120 FAUST AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3542
Practice Address - Country:US
Practice Address - Phone:313-680-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006749101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor