Provider Demographics
NPI:1669726469
Name:SMITH, DELILAH (LPC)
Entity type:Individual
Prefix:
First Name:DELILAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1506
Mailing Address - Country:US
Mailing Address - Phone:313-372-3826
Mailing Address - Fax:313-372-3990
Practice Address - Street 1:12800 KELLY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1506
Practice Address - Country:US
Practice Address - Phone:313-372-3826
Practice Address - Fax:313-372-3990
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional