Provider Demographics
NPI:1265248488
Name:SMITH, MARQUETTA ELAINE (MSSW, PCS, CCC)
Entity type:Individual
Prefix:MS
First Name:MARQUETTA
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSSW, PCS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HARBOUR TOWN CV
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8042
Mailing Address - Country:US
Mailing Address - Phone:404-692-3245
Mailing Address - Fax:
Practice Address - Street 1:65 HARBOUR TOWN CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8042
Practice Address - Country:US
Practice Address - Phone:404-692-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral