Provider Demographics
NPI:1720211063
Name:SMITH, LAURA KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHRYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KATHRYN
Other - Last Name:GRESHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:555 SUN VALLEY DR STE L1
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5630
Mailing Address - Country:US
Mailing Address - Phone:404-394-1096
Mailing Address - Fax:404-990-3531
Practice Address - Street 1:555 SUN VALLEY DR STE L1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5630
Practice Address - Country:US
Practice Address - Phone:404-394-1096
Practice Address - Fax:404-990-3531
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical