Provider Demographics
NPI:1669163820
Name:SMITH, DOMONIQUE LENAE (MSW)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:LENAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42135 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2842
Mailing Address - Country:US
Mailing Address - Phone:248-779-5763
Mailing Address - Fax:
Practice Address - Street 1:34441 8 MILE RD STE 116
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:810-302-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851116730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker