Provider Demographics
NPI:1932690260
Name:THERAPY WITH ANGELA SMITH LLC
Entity Type:Organization
Organization Name:THERAPY WITH ANGELA SMITH LLC
Other - Org Name:ANGELA SMITH, LPC, NCC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-233-2806
Mailing Address - Street 1:521 WOODLAWN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1951
Mailing Address - Country:US
Mailing Address - Phone:706-233-2806
Mailing Address - Fax:
Practice Address - Street 1:109 JOHN MADDOX DR NW STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1453
Practice Address - Country:US
Practice Address - Phone:706-233-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELA SMITH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-22
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty