Organization Name: | SMITH COUNSELING CLINIC INC |
NPI Number: | 1922263326 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY W SMITH (COUNSELOR) |
Mailing Address: | 804 N Wiley Ave Donalsonville |
State: | GA US |
Postal Code: | 398451120 |
Phone Number: | 2295248994 |
Fax Number: | 2295241272 |
NPI Enumeration Date: | 07/24/2008 |
NPI Last Update Date: | 07/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC004048 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |