Provider Demographics
NPI:1639421407
Name:SMITH, ALICIA DARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DARLENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:DARLENE
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1125 LAUREN WAY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3887
Mailing Address - Country:US
Mailing Address - Phone:423-255-2357
Mailing Address - Fax:
Practice Address - Street 1:1125 LAUREN WAY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3887
Practice Address - Country:US
Practice Address - Phone:423-255-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health