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NPI Code Detail

MEDICARE: MS. CHARLENE MARIE SMITH

MEDICARE:  MS. CHARLENE MARIE SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC008628GA

General Provider Information

NPI Number : 1568083202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHARLENE MARIE SMITH
Provider Business Mailing Address
First Line : 2323 PIEDMONT RD NE APT 2124
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3419
Country : US
Telephone Number : 252-506-1088
Fax Number :
Provider Business Practice Location Address
First Line : 2323 PIEDMONT RD NE APT 2124
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3419
Country : US
Telephone Number : 252-506-1088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2020
Last Update Date : 05/05/2020

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Directions to “ MS. CHARLENE MARIE SMITH ” Practice Location

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