Provider Demographics
NPI:1235868563
Name:SMITH, CEVONE (LMSW)
Entity Type:Individual
Prefix:
First Name:CEVONE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 W 9 MILE RD STE 615
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4851
Mailing Address - Country:US
Mailing Address - Phone:248-499-4312
Mailing Address - Fax:
Practice Address - Street 1:16000 W 9 MILE RD STE 615
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4851
Practice Address - Country:US
Practice Address - Phone:248-499-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011094891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical