Provider Demographics
NPI:1578188751
Name:SMITH, DIMIKA NEQUAI (EDD)
Entity Type:Individual
Prefix:DR
First Name:DIMIKA
Middle Name:NEQUAI
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30848 HUNTSMAN DR E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1390
Mailing Address - Country:US
Mailing Address - Phone:248-249-1651
Mailing Address - Fax:
Practice Address - Street 1:30848 HUNTSMAN DR E
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1390
Practice Address - Country:US
Practice Address - Phone:248-249-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator