Provider Demographics
NPI:1194281121
Name:SMITH, EVELYN ASH (LCSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ASH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:ASH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:211 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7790
Mailing Address - Country:US
Mailing Address - Phone:229-400-3407
Mailing Address - Fax:
Practice Address - Street 1:211 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7790
Practice Address - Country:US
Practice Address - Phone:229-400-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0087161041C0700X
FLSW147631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty