Individual
MISS JALISA SHAWTAE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLMSW
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
01/21/2025
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