Provider Demographics
NPI:1477321669
Name:DOUGLAS-SMITH, MICHELE (LICENSE SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DOUGLAS-SMITH
Suffix:
Gender:F
Credentials:LICENSE SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8434
Mailing Address - Country:US
Mailing Address - Phone:855-436-7792
Mailing Address - Fax:
Practice Address - Street 1:55 WILLOW LN
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8434
Practice Address - Country:US
Practice Address - Phone:855-436-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05765600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor