Provider Demographics
NPI:1992432546
Name:SMITH, VANESHA D (LLMSW)
Entity type:Individual
Prefix:
First Name:VANESHA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 HOLMES RD APT 4
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3971
Mailing Address - Country:US
Mailing Address - Phone:517-574-6791
Mailing Address - Fax:
Practice Address - Street 1:1234 HOLMES RD APT 4
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3971
Practice Address - Country:US
Practice Address - Phone:517-574-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511151261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical