Provider Demographics
NPI:1679623185
Name:SMITH, VERONICA (MS)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 TEXEL LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2736
Mailing Address - Country:US
Mailing Address - Phone:678-409-2850
Mailing Address - Fax:
Practice Address - Street 1:957 TEXEL LN
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2736
Practice Address - Country:US
Practice Address - Phone:678-409-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional