Provider Demographics
NPI:1972735314
Name:SMITH, CORDIA YVETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CORDIA
Middle Name:YVETTE
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 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:678-469-3947
Mailing Address - Fax:770-438-6172
Practice Address - Street 1:300 VILLAGE GREEN CIR SE
Practice Address - Street 2:SUITE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3476
Practice Address - Country:US
Practice Address - Phone:678-469-3947
Practice Address - Fax:770-438-6172
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical