Healthcare Provider Details

I. General information

NPI: 1831466341
Provider Name (Legal Business Name): FREDERICK SMITH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8034 GLEN VALLEY DR
MIDLAND GA
31820-4346
US

IV. Provider business mailing address

8034 GLEN VALLEY DR
MIDLAND GA
31820-4346
US

V. Phone/Fax

Practice location:
  • Phone: 706-521-2131
  • Fax:
Mailing address:
  • Phone: 706-527-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010961
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: