Impact Community Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801091775 Issued in MI

Legal business name

IMPACT COMMUNITY SERVICES

Practice address

18353 W McNichols Rd
Suite #6
Detroit, MI 48219-4199

Phone

(866) 538-2131

Fax

(855) 284-2226

NPI assigned

Dec 11, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anitra Shawnta Smith, LLMSW

Title

Founder/Ceo

Phone

(866) 538-2131

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378425600000",
    "number": "1992073548",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "18701 GRAND RIVER AVE",
            "address_2": "SUITE 345",
            "city": "DETROIT",
            "state": "MICHIGAN",
            "postal_code": "48223",
            "telephone_number": "866-538-2131",
            "fax_number": "855-284-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18353 W MCNICHOLS RD",
            "address_2": "SUITE #6",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482194199",
            "telephone_number": "866-538-2131",
            "fax_number": "855-284-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-11",
        "last_updated": "2013-09-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANITRA",
        "authorized_official_middle_name": "SHAWNTA",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "18665382131",
        "authorized_official_credential": "LLMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801091775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.