Provider Demographics
NPI:1982868592
Name:LATTIMORE-SMITH, MICHELE KIM (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:KIM
Last Name:LATTIMORE-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 1:381 SUNDERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7957
Mailing Address - Country:US
Mailing Address - Phone:478-451-3047
Mailing Address - Fax:
Practice Address - Street 1:381 SUNDERLAND WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7957
Practice Address - Country:US
Practice Address - Phone:478-451-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional