Provider Demographics
NPI:1922732411
Name:SMITH, SHAWNDRIA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNDRIA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 COMMERCE DR SW STE 1A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6647
Mailing Address - Country:US
Mailing Address - Phone:404-805-4348
Mailing Address - Fax:470-777-2501
Practice Address - Street 1:997 COMMERCE DR SW STE 1A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6647
Practice Address - Country:US
Practice Address - Phone:404-805-4348
Practice Address - Fax:470-777-2501
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health