Provider Demographics
NPI:1558865493
Name:SMITH, TATIANA CABRAL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:CABRAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1962
Mailing Address - Country:US
Mailing Address - Phone:912-508-1097
Mailing Address - Fax:
Practice Address - Street 1:12 1/2 W STATE ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-3611
Practice Address - Country:US
Practice Address - Phone:912-766-0600
Practice Address - Fax:912-766-0600
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
GALPC012842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor