Provider Demographics
NPI:1407476773
Name:SMITH, ANGELA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANGELA SMITH LPC
Mailing Address - Street 1:521 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1951
Mailing Address - Country:US
Mailing Address - Phone:706-233-2806
Mailing Address - Fax:
Practice Address - Street 1:109 JOHN MADDOX DR NW STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1453
Practice Address - Country:US
Practice Address - Phone:706-233-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional