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NPI Code Detail

MEDICARE: MISS NICOLE RENE SMITH LPC

MEDICARE: MISS NICOLE RENE SMITH LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC007053GA

General Provider Information

NPI Number : 1790105021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS NICOLE RENE SMITH LPC
Provider Business Mailing Address
First Line : PO BOX 863
Second Line :
City : DALTON
State : GA
Zip : 30722-0863
Country : US
Telephone Number : 706-279-0405
Fax Number : 706-279-4190
Provider Business Practice Location Address
First Line : 1414 DUG GAP RD
Second Line :
City : DALTON
State : GA
Zip : 30720-5007
Country : US
Telephone Number : 706-279-0405
Fax Number : 706-279-4190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2014
Last Update Date : 04/25/2014

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Directions to “ MISS NICOLE RENE SMITH LPC” Practice Location

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