Provider Demographics
NPI:1952124596
Name:SMITH, N'DIA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:N'DIA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:N'DIA
Other - Middle Name:SMITH
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 BEVERLY PARK CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6028
Mailing Address - Country:US
Mailing Address - Phone:678-215-3109
Mailing Address - Fax:
Practice Address - Street 1:200 BEVERLY PARK CT
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6028
Practice Address - Country:US
Practice Address - Phone:678-215-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0071581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical