Individual
GINA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPRM
Contact information
Practice address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
(313) 345-4315
Mailing address
15941 FAIRFIELD ST, DETROIT, MI 48238-4123
(313) 345-4310
(313) 345-4615
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204986314
—
MI
Enumeration date
07/11/2018
Last updated
07/11/2018
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