Healthcare Provider Details

I. General information

NPI: 1104214360
Provider Name (Legal Business Name): LATANDRIA SMITH PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 RADIUM SPRINGS ROAD
ALBANY GA
31705
US

IV. Provider business mailing address

1314 RADIUM SPRINGS ROAD
ALBANY GA
31705
US

V. Phone/Fax

Practice location:
  • Phone: 229-328-1088
  • Fax:
Mailing address:
  • Phone: 229-328-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26406
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: