Provider Demographics
NPI:1861837502
Name:SMITH, SHANTA NATRE (MS, LLBSW, CADC)
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:NATRE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LLBSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 WHISPERING OAK DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5541
Mailing Address - Country:US
Mailing Address - Phone:810-308-8792
Mailing Address - Fax:
Practice Address - Street 1:529 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-232-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086480101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)