Provider Demographics
NPI:1942981501
Name:SMITH, SHAWNA MARIE (BS)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD STE 127
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3878
Mailing Address - Country:US
Mailing Address - Phone:734-344-5269
Mailing Address - Fax:734-430-8188
Practice Address - Street 1:3426 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2315
Practice Address - Country:US
Practice Address - Phone:313-992-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)