Provider Demographics
NPI:1740901750
Name:LAKESIDE OF THE SMOKIES COUNSELING PLLC
Entity type:Organization
Organization Name:LAKESIDE OF THE SMOKIES COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-333-2654
Mailing Address - Street 1:1121 HILL ST
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4813
Mailing Address - Country:US
Mailing Address - Phone:865-333-2654
Mailing Address - Fax:
Practice Address - Street 1:1121 HILL ST
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4813
Practice Address - Country:US
Practice Address - Phone:865-333-2654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health