Provider Demographics
NPI:1497182943
Name:SMITH, D'ANDRE TL (LLP)
Entity Type:Individual
Prefix:MR
First Name:D'ANDRE
Middle Name:TL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 UNION AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5426
Mailing Address - Country:US
Mailing Address - Phone:616-828-8144
Mailing Address - Fax:
Practice Address - Street 1:1009 44TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4480
Practice Address - Country:US
Practice Address - Phone:269-459-1818
Practice Address - Fax:269-365-9951
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6301017808103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health