Provider Demographics
NPI:1730710088
Name:SMITH, MICHELE DIANE (MA LMHC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:DIANE
Other - Last Name:CRANDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA RMHCI
Mailing Address - Street 1:1575 INDIAN RIVER BLVD
Mailing Address - Street 2:C110
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-888-0212
Mailing Address - Fax:
Practice Address - Street 1:1575 INDIAN RIVER BLVD
Practice Address - Street 2:C110
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-888-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH25067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health