Provider Demographics
NPI:1457753196
Name:SMITH, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8652
Mailing Address - Country:US
Mailing Address - Phone:231-343-0445
Mailing Address - Fax:269-408-8235
Practice Address - Street 1:445 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2203
Practice Address - Country:US
Practice Address - Phone:231-739-4359
Practice Address - Fax:231-733-6151
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)