Healthcare Provider Details

I. General information

NPI: 1871886432
Provider Name (Legal Business Name): BSMITH CONSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4046 HIGHWAY 154 STE 114
NEWNAN GA
30265-2330
US

IV. Provider business mailing address

4046 HWY 154, SUITE 114
NEWNAN GA
30265
US

V. Phone/Fax

Practice location:
  • Phone: 678-253-1715
  • Fax:
Mailing address:
  • Phone: 678-253-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLPC003014
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC003014
License Number StateGA

VIII. Authorized Official

Name: MRS. BEVERLY HARRIS
Title or Position: CEO
Credential: LPC, NCC, HS-DCP
Phone: 678-523-1715