Healthcare Provider Details

I. General information

NPI: 1801733696
Provider Name (Legal Business Name): CONSTANCE ELAINE WOODEN-SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 AUBURN RD STE 118
DACULA GA
30019-1618
US

IV. Provider business mailing address

1862 AUBURN RD STE 118
DACULA GA
30019-1618
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 646-941-7645
  • Fax: 929-596-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCWS006680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: