Provider Demographics
NPI:1316959901
Name:SMITH, REBECCA K (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:SMITH
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:113 S PERRY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4811
Mailing Address - Country:US
Mailing Address - Phone:706-204-9226
Mailing Address - Fax:
Practice Address - Street 1:113 S PERRY ST STE 206
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4811
Practice Address - Country:US
Practice Address - Phone:706-204-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional