Provider Demographics
NPI:1841230745
Name:SMITH, CARLA M (CSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 LANNOO ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2138
Mailing Address - Country:US
Mailing Address - Phone:313-695-8344
Mailing Address - Fax:
Practice Address - Street 1:4777 E OUTER DR
Practice Address - Street 2:STE 183
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3241
Practice Address - Country:US
Practice Address - Phone:586-738-4374
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010781781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical