Provider Demographics
NPI:1740644459
Name:SMITH, TEKESHA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TEKESHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TEKESHA
Other - Middle Name:
Other - Last Name:WIDEMAN-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3352 GRACE FARM LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-0100
Mailing Address - Country:US
Mailing Address - Phone:678-542-8169
Mailing Address - Fax:
Practice Address - Street 1:3717 LEISURE CT
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4317
Practice Address - Country:US
Practice Address - Phone:678-542-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical