Provider Demographics
NPI:1407154719
Name:SMITH, LINDA (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GARLAND ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2271
Mailing Address - Country:US
Mailing Address - Phone:231-486-0805
Mailing Address - Fax:231-668-6618
Practice Address - Street 1:221 GARLAND ST
Practice Address - Street 2:SUITE J
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2271
Practice Address - Country:US
Practice Address - Phone:231-486-0805
Practice Address - Fax:231-668-6618
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical