Provider Demographics
NPI:1659613958
Name:SMITH, MARCIA MARIE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 CREATWOOD TRL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:513-739-9220
Mailing Address - Fax:
Practice Address - Street 1:6488 SPRING ST STE 102
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-949-1595
Practice Address - Fax:770-489-7521
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional