Individual
TIMOTHY ROBERT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADAC
Contact information
Practice address
4646 JOHN R ST, MENTAL HEALTH SERVICES (11MH-PS), DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
4110 ALLEGHENY DR, TROY, MI 48085-3642
(313) 576-1000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0834
MI
Other
Enumeration date
08/24/2006
Last updated
06/15/2011
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