Provider Demographics
NPI:1699348441
Name:SMITH, KRISTIN ASHLEY (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ASHLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 JAMES B RIVERS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2950
Mailing Address - Country:US
Mailing Address - Phone:404-626-8941
Mailing Address - Fax:
Practice Address - Street 1:6570 JAMES B RIVERS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2950
Practice Address - Country:US
Practice Address - Phone:404-626-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical