Provider Demographics
NPI:1538676309
Name:SMITH, JASMINE (LMSW-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 HONEYTREE BLVD BLDG 60
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4109
Mailing Address - Country:US
Mailing Address - Phone:313-467-3506
Mailing Address - Fax:
Practice Address - Street 1:5958 N CANTON CENTER RD STE 900
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2740
Practice Address - Country:US
Practice Address - Phone:734-737-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X
MI6801109336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty