Basic Information
| Provider Information | |||||||||
| NPI: | 1225413818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | ANNE-HASHOIAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 RIVER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483272887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484202885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6548 TOWN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483464823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006931916 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401010293 | MI | Y | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6401010293 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.