Provider Demographics
NPI:1770858979
Name:SMITH, CAROLYN ELAINE (LAPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N DRUID HILLS RD NE
Mailing Address - Street 2:SUITE J
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3919
Mailing Address - Country:US
Mailing Address - Phone:678-333-9449
Mailing Address - Fax:404-248-1558
Practice Address - Street 1:2910 N DRUID HILLS RD NE
Practice Address - Street 2:SUITE J
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3919
Practice Address - Country:US
Practice Address - Phone:678-333-9449
Practice Address - Fax:404-248-1558
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health