Provider Demographics
NPI:1124309851
Name:SMITH, KASEY (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 S. MILLEDGE AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605
Mailing Address - Country:US
Mailing Address - Phone:706-425-2809
Mailing Address - Fax:678-302-0196
Practice Address - Street 1:188 S. MILLEDGE AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605
Practice Address - Country:US
Practice Address - Phone:706-425-2809
Practice Address - Fax:678-302-0196
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker