Provider Demographics
NPI:1467838763
Name:SUSAN P. SMITH, LPC
Entity Type:Organization
Organization Name:SUSAN P. SMITH, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-572-7505
Mailing Address - Street 1:3135 SEVEN PINES CT
Mailing Address - Street 2:#208
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5867
Mailing Address - Country:US
Mailing Address - Phone:770-572-7505
Mailing Address - Fax:
Practice Address - Street 1:2255 CUMBERLAND PKWY SE
Practice Address - Street 2:BLDG 500; SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4515
Practice Address - Country:US
Practice Address - Phone:770-572-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0004523251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health