Provider Demographics
NPI:1356075840
Name:SMITH, MICHELLE CLARICE (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CLARICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2507
Mailing Address - Country:US
Mailing Address - Phone:864-938-2100
Mailing Address - Fax:
Practice Address - Street 1:302 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2507
Practice Address - Country:US
Practice Address - Phone:864-938-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health