Provider Demographics
NPI:1851678668
Name:SMITH, LEKA CASSINIA (NCTMB)
Entity Type:Individual
Prefix:MS
First Name:LEKA
Middle Name:CASSINIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 W 9 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4404
Mailing Address - Country:US
Mailing Address - Phone:313-850-1353
Mailing Address - Fax:313-254-6988
Practice Address - Street 1:17515 W 9 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4404
Practice Address - Country:US
Practice Address - Phone:313-406-9668
Practice Address - Fax:313-254-6988
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist