Provider Demographics
NPI:1639447287
Name:SMITH, ANITRA SHAWNTA (LLMSW)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:SHAWNTA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 GRAND RIVER AVE.
Mailing Address - Street 2:SUITE 345
Mailing Address - City:DETROIT
Mailing Address - State:MICHIGAN
Mailing Address - Zip Code:48223
Mailing Address - Country:UM
Mailing Address - Phone:866-538-2131
Mailing Address - Fax:855-284-2226
Practice Address - Street 1:9329 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1260
Practice Address - Country:US
Practice Address - Phone:313-477-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010917751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical