Individual
DR. CHARLES MICHAEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
333 N 2ND ST, SUITE # 304, NILES, MI 49120-2258
(269) 687-9364
(269) 782-5344
Mailing address
333 N 2ND ST, SUITE # 304, NILES, MI 49120-2258
(269) 687-9364
(269) 782-5344
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301008141
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68-0-A1-3124
BCBSN PARTICIPATING PROV
MI
Enumeration date
01/19/2007
Last updated
07/08/2007
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