Provider Demographics
NPI:1831540343
Name:SMITH, TIESE VERONICA
Entity type:Individual
Prefix:
First Name:TIESE
Middle Name:VERONICA
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 1:14733 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9545
Mailing Address - Country:US
Mailing Address - Phone:734-243-8707
Mailing Address - Fax:734-243-8707
Practice Address - Street 1:14733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9545
Practice Address - Country:US
Practice Address - Phone:734-243-8707
Practice Address - Fax:734-243-8707
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)