Provider Demographics
NPI:1316254618
Name:SMITH, LETA ANNE (LFMC)
Entity type:Individual
Prefix:MS
First Name:LETA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LFMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5514
Mailing Address - Country:US
Mailing Address - Phone:229-890-2288
Mailing Address - Fax:229-890-2289
Practice Address - Street 1:600 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5514
Practice Address - Country:US
Practice Address - Phone:229-890-2288
Practice Address - Fax:229-890-2289
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist