Provider Demographics
NPI:1649704438
Name:SMITH, MICHELLE DESILEE (MA NCC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DESILEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 ADAMS POINTE BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046
Mailing Address - Country:US
Mailing Address - Phone:724-591-6733
Mailing Address - Fax:
Practice Address - Street 1:229 ADAMS POINTE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-4699
Practice Address - Country:US
Practice Address - Phone:724-591-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional