Provider Demographics
NPI:1053052258
Name:O'BRIEN SMITH, CARA KELLY (LCSW)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:KELLY
Last Name:O'BRIEN SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 POLO CLUB DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1283
Mailing Address - Country:US
Mailing Address - Phone:404-643-9439
Mailing Address - Fax:
Practice Address - Street 1:1067 POLO CLUB DR NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1283
Practice Address - Country:US
Practice Address - Phone:404-643-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical