Provider Demographics
NPI:1831440072
Name:SMITH, CHARITA NICOLE (LCSW, MAC)
Entity type:Individual
Prefix:MS
First Name:CHARITA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COMMERCIAL CT STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3675
Mailing Address - Country:US
Mailing Address - Phone:912-503-5744
Mailing Address - Fax:912-335-6559
Practice Address - Street 1:300 COMMERCIAL CT STE F
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2676
Practice Address - Country:US
Practice Address - Phone:912-503-5744
Practice Address - Fax:912-335-6559
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005401104100000X
GACSW0056451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker