Provider Demographics
NPI:1720130354
Name:SMITH, PATRIZE J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRIZE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1040 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1800
Mailing Address - Country:US
Mailing Address - Phone:770-346-7611
Mailing Address - Fax:
Practice Address - Street 1:1040 CAMBRIDGE SQ
Practice Address - Street 2:SUITE A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1800
Practice Address - Country:US
Practice Address - Phone:770-346-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0013971041C0700X
MA105332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist