Healthcare Provider Details

I. General information

NPI: 1104309707
Provider Name (Legal Business Name): SHARIANNE KIONA SMITH-MCLEAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 DULUTH HWY STE F
LAWRENCEVILLE GA
30043-5143
US

IV. Provider business mailing address

1495 DULUTH HWY STE F #1398
LAWRENCEVILLE GA
30043
US

V. Phone/Fax

Practice location:
  • Phone: 347-937-9525
  • Fax:
Mailing address:
  • Phone: 347-937-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017434
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: