Provider Demographics
NPI:1235734831
Name:SMITH, HERSCHEL BRETTEN (LPC)
Entity Type:Individual
Prefix:
First Name:HERSCHEL
Middle Name:BRETTEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 OLD SALEM RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-2388
Mailing Address - Country:US
Mailing Address - Phone:678-313-7230
Mailing Address - Fax:
Practice Address - Street 1:319 OLD SALEM RD
Practice Address - Street 2:
Practice Address - City:MINERAL BLUFF
Practice Address - State:GA
Practice Address - Zip Code:30559-2388
Practice Address - Country:US
Practice Address - Phone:678-313-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional