Provider Demographics
NPI:1538582192
Name:SMITH, EFRION
Entity type:Individual
Prefix:
First Name:EFRION
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28755 SCHOENHERR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4395
Mailing Address - Country:US
Mailing Address - Phone:586-920-2546
Mailing Address - Fax:586-920-2200
Practice Address - Street 1:28755 SCHOENHERR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4395
Practice Address - Country:US
Practice Address - Phone:586-920-2546
Practice Address - Fax:586-920-2200
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010809861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical