Healthcare Provider Details

I. General information

NPI: 1356602916
Provider Name (Legal Business Name): LATOYA LENAE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATOYA SKINNER

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30046-8444
US

IV. Provider business mailing address

17 VILLA CT SE
SMYRNA GA
30080-4570
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-2395
  • Fax: 678-990-3997
Mailing address:
  • Phone: 404-387-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW005795
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: