Provider Demographics
NPI:1497243356
Name:SMITH, SAMUEL II (NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:SMITH
Suffix:II
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 STILESBORO RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7744
Mailing Address - Country:US
Mailing Address - Phone:770-852-8686
Mailing Address - Fax:770-852-8696
Practice Address - Street 1:5150 STILESBORO RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7744
Practice Address - Country:US
Practice Address - Phone:770-852-8686
Practice Address - Fax:770-852-8696
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty