Doctor Name: | KIMBERLY SMITH |
NPI Number: | 1417321571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | NONE |
Business Practice Address: | 180 Water Oak Dr Cedartown, GA - 301252095 |
Business Phone Number: | 7707482225 |
Business Fax Number: | |
Mailing Address: | 180 Water Oak Dr, CEDARTOWN |
State: | GA |
Postal Code: | 301252095 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/30/2015 |
NPI Last Update Date: | 11/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | NONE |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |