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General NPI Number Information
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NPI Number | 1922486737
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Entity Type | Individual
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Provider Name | PELBA JEAN SMITH
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 2050 WALTON WAY
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City | AUGUSTA
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State | GA
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Zip | 30904-2305
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Country | US
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Telephone | 706-729-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 902 BURLINGTON DR
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City | EVANS
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State | GA
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Zip | 30809-4512
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Country | US
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Telephone | 706-951-8150
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11185
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License Number State | SC
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