MEDICARE: LANA SMITH CSW006563

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
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570569761	OTHER	SC	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750779237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA SMITH CSW006563

Provider Business Mailing Address
First Line	:	1105 GREGG HWY
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29801-6341
Country	:	US
Telephone Number	:	803-649-1900
Fax Number	:	803-643-2926

Provider Business Practice Location Address
First Line	:	1145 PINE LAKE DR
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-7926
Country	:	US
Telephone Number	:	404-522-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	11/04/2020

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