Provider Demographics
NPI:1598177883
Name:WILLIAMS-SMITH, ELANA
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:WILLIAMS-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 1:4707 VINEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1886
Mailing Address - Country:US
Mailing Address - Phone:313-361-6135
Mailing Address - Fax:313-361-6211
Practice Address - Street 1:4707 VINEWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1886
Practice Address - Country:US
Practice Address - Phone:313-361-6135
Practice Address - Fax:313-361-6211
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)