Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1194331975 |
---|---|
Provider Name | Dr. Lisa Marie Smith |
First Address | Smyrna, GA 30080-4118 |
Second Address | Marietta, GA 30067-8621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2020 |
Last Update Date | 17/09/2020 |