Provider Demographics
NPI:1477600997
Name:SMITH, PAMELA SUZANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUZANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
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 466
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-0466
Mailing Address - Country:US
Mailing Address - Phone:478-474-7177
Mailing Address - Fax:
Practice Address - Street 1:621 CHICKASAW DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-6409
Practice Address - Country:US
Practice Address - Phone:478-972-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist