Provider Demographics
NPI:1790008464
Name:SMITH, ANGELA (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ELMO ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3711
Mailing Address - Country:US
Mailing Address - Phone:229-380-0881
Mailing Address - Fax:
Practice Address - Street 1:906 ELMO ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3711
Practice Address - Country:US
Practice Address - Phone:229-380-0881
Practice Address - Fax:229-380-0883
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional