Provider Demographics
NPI:1427604693
Name:SMITH, CHANICE LACHELLE
Entity Type:Individual
Prefix:
First Name:CHANICE
Middle Name:LACHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 KENNETH ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2206
Mailing Address - Country:US
Mailing Address - Phone:810-744-2506
Mailing Address - Fax:
Practice Address - Street 1:1330 KENNETH ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2206
Practice Address - Country:US
Practice Address - Phone:810-744-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker