Provider Demographics
NPI:1962832907
Name:SMITH, STEPHEN LAMAR
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAMAR
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 KENDALL LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7099
Mailing Address - Country:US
Mailing Address - Phone:404-274-8055
Mailing Address - Fax:
Practice Address - Street 1:424 KENDALL LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7099
Practice Address - Country:US
Practice Address - Phone:404-274-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health