Provider Demographics
NPI:1023839727
Name:SMITH, CHRISTINE ALEXANDRIA (CHW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALEXANDRIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19390 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2049
Mailing Address - Country:US
Mailing Address - Phone:248-820-4266
Mailing Address - Fax:
Practice Address - Street 1:22000 GRAND RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3391
Practice Address - Country:US
Practice Address - Phone:313-412-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI112761477172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker