Provider Demographics
NPI:1396040887
Name:SMITH HARVEY, WAKISHA EVELYN (LPC)
Entity Type:Individual
Prefix:
First Name:WAKISHA
Middle Name:EVELYN
Last Name:SMITH HARVEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WAKISHA
Other - Middle Name:EVELYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 FAIRMONT WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5429
Mailing Address - Country:US
Mailing Address - Phone:770-964-8858
Mailing Address - Fax:
Practice Address - Street 1:853 BATTLECREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1919
Practice Address - Country:US
Practice Address - Phone:770-478-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional