Provider Demographics
NPI:1699489898
Name:SMOLSKI, AMY (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SMOLSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50258 VAN DYKE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1374
Mailing Address - Country:US
Mailing Address - Phone:586-884-4714
Mailing Address - Fax:
Practice Address - Street 1:50258 VAN DYKE AVE STE A
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-1374
Practice Address - Country:US
Practice Address - Phone:586-884-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013255101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT651585734010Medicaid