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General NPI Number Information
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NPI Number | 1336806207
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Entity Type | Individual
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Provider Name | DAVID SMITH KAMUELYU JR. CADC II
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Gender | Male
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 2855 LAWRENCEVILLE SUWANEE RD
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City | SUWANEE
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State | GA
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Zip | 30024-3563
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Country | US
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Telephone | 770-904-3955
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 STATION CENTER BLVD
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City | SUWANEE
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State | GA
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Zip | 30024-8462
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Country | US
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Telephone | 763-898-8539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8180
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License Number State | GA
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