Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | GA | |
N | 101YP1600X | Pastoral Counselor | GA | |
N | 101YP2500X | Professional Counselor | ||
N | 106S00000X | Behavior Technician |
NPI | 1306470406 |
---|---|
Provider Name | David Smith |
First Address | Stockbridge, GA 30281-4460 |
Second Address | Stockbridge, GA 30281-4460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 27/02/2020 |