Provider Demographics
NPI:1407432990
Name:SMITH, SAMIRA DESREE (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:DESREE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:REEDY SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3203 FARM LAND CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4923
Mailing Address - Country:US
Mailing Address - Phone:404-200-7754
Mailing Address - Fax:
Practice Address - Street 1:8218 HAZELBRAND RD NE STE B&C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1509
Practice Address - Country:US
Practice Address - Phone:404-200-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical