Provider Demographics
NPI:1225338122
Name:SMITH, LAURIE (LMSW, CDE)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S MAIN ST
Mailing Address - Street 2:STE 101B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1060
Mailing Address - Country:US
Mailing Address - Phone:248-475-4701
Mailing Address - Fax:248-475-5777
Practice Address - Street 1:705 S MAIN ST
Practice Address - Street 2:STE 101B
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1060
Practice Address - Country:US
Practice Address - Phone:734-796-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical