Provider Demographics
NPI:1811027113
Name:SMITH, LYNDA LOUISE (FAODP, MA, MDIV)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FAODP, MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2771
Mailing Address - Country:US
Mailing Address - Phone:313-617-4615
Mailing Address - Fax:
Practice Address - Street 1:5470 CHENE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-2746
Practice Address - Country:US
Practice Address - Phone:313-875-5521
Practice Address - Fax:313-267-0549
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)