Provider Demographics
NPI:1396182697
Name:SMITH, ANDREA LAUREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LAUREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 STEKETEE RD NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301
Mailing Address - Country:US
Mailing Address - Phone:616-240-4856
Mailing Address - Fax:
Practice Address - Street 1:255 COLRAIN ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-1013
Practice Address - Country:US
Practice Address - Phone:616-988-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092746104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker