Provider Demographics
NPI:1750680211
Name:SMITH, NEDGRA (LPC LLMSW)
Entity type:Individual
Prefix:MS
First Name:NEDGRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC LLMSW
Other - Prefix:
Other - First Name:NEDRA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7640 TIMBERCREEK CT APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7004
Mailing Address - Country:US
Mailing Address - Phone:269-358-0271
Mailing Address - Fax:
Practice Address - Street 1:400 136TH AVE STE 416
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2905
Practice Address - Country:US
Practice Address - Phone:616-952-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI68011003491041C0700X
MI6401015959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical