Provider Demographics
NPI:1760254551
Name:SMITH, CHASE (CADC DP-BA)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CADC DP-BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17961 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1168
Mailing Address - Country:US
Mailing Address - Phone:419-261-1471
Mailing Address - Fax:
Practice Address - Street 1:1108 LAPEER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2704
Practice Address - Country:US
Practice Address - Phone:810-232-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)