Healthcare Provider Details

I. General information

NPI: 1538963574
Provider Name (Legal Business Name): KIERA SMITH LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CHURCH ST
FLOWERY BRANCH GA
30542-5781
US

IV. Provider business mailing address

5505 CHURCH ST
FLOWERY BRANCH GA
30542-5781
US

V. Phone/Fax

Practice location:
  • Phone: 678-828-7301
  • Fax:
Mailing address:
  • Phone: 678-828-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010236
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: