Provider Demographics
NPI:1346473188
Name:SMITH, NECA C (LPC)
Entity Type:Individual
Prefix:
First Name:NECA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
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:PO BOX 1423
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-1423
Mailing Address - Country:US
Mailing Address - Phone:404-537-1821
Mailing Address - Fax:770-593-9110
Practice Address - Street 1:3300 BUCKEYE RD
Practice Address - Street 2:SUITE 677
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4229
Practice Address - Country:US
Practice Address - Phone:404-537-1821
Practice Address - Fax:770-593-1821
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
9977333OtherAETNA