Provider Demographics
NPI:1871185629
Name:SMITH, AUTUMN LOREAL (LLMSW)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LOREAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 ERICKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-1147
Mailing Address - Country:US
Mailing Address - Phone:231-725-5280
Mailing Address - Fax:
Practice Address - Street 1:125 CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3331
Practice Address - Country:US
Practice Address - Phone:231-720-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical