Provider Demographics
NPI:1922490465
Name:SMITH, ALYSSA JEAN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ANN ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6247
Mailing Address - Country:US
Mailing Address - Phone:616-914-6510
Mailing Address - Fax:
Practice Address - Street 1:2730 5 MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6518
Practice Address - Country:US
Practice Address - Phone:616-426-9159
Practice Address - Fax:616-222-0294
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011003381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical