Provider Demographics
NPI:1831444967
Name:SMOLKO, MARYANN F (LPC)
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:F
Last Name:SMOLKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GALLERY CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2707
Mailing Address - Country:US
Mailing Address - Phone:770-713-4574
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 710
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7157
Practice Address - Country:US
Practice Address - Phone:770-792-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional