Provider Demographics
NPI:1699543959
Name:SMITH, BIANCA H (CHAPLAIN)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:CHAPLAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 MABLETON PKWY SW STE 108
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3357
Mailing Address - Country:US
Mailing Address - Phone:888-322-1316
Mailing Address - Fax:888-322-1316
Practice Address - Street 1:5701 MABLETON PKWY SW STE 108
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3357
Practice Address - Country:US
Practice Address - Phone:888-322-1316
Practice Address - Fax:888-322-1316
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174H00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174H00000XOther Service ProvidersHealth Educator