Provider Demographics
NPI:1386363026
Name:SMITH, AMANDA GAIL (CAC II)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MCGAHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC II
Mailing Address - Street 1:465 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-8580
Mailing Address - Country:US
Mailing Address - Phone:706-455-0090
Mailing Address - Fax:
Practice Address - Street 1:230 RIVERSTONE PKWY STE C
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6414
Practice Address - Country:US
Practice Address - Phone:470-221-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3610-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)