Provider Demographics
NPI:1134661010
Name:SMITH, TASCHOVIA (LPC, MAC, CCDP-D)
Entity type:Individual
Prefix:
First Name:TASCHOVIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, MAC, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 MOUNT ZION RD APT 3902
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7849
Mailing Address - Country:US
Mailing Address - Phone:404-955-8274
Mailing Address - Fax:
Practice Address - Street 1:3196 MOUNT ZION RD #3902
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7849
Practice Address - Country:US
Practice Address - Phone:404-955-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0008917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional