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Individual

DIANE SHARON SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD MSW APRN BC CNS

Contact information

Practice address
119 KERCHEVAL AVE, GROSSE POINTE FARMS, MI 48236
(313) 881-2010
(313) 882-7424
Mailing address
1506 LOCHMOOR BOULEVARD, GROSSE POINTE WOODS, MI 48236-4016
(313) 885-0099
(313) 882-7424

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301007629
MI
1041C0700X
Clinical Social Worker
6801017113
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
110675
MI
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
110675
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5008661290
BLUE CROSS BLUE SHIELD
MI
01
6301007629
CLINICAL PSYCHOLOGIST
MI
01
6801017113
CMSW
MI
Enumeration date
05/04/2007
Last updated
09/11/2025
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