Provider Demographics
NPI:1902620578
Name:SMITH, CHRISTOPHER SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANNON
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3808
Mailing Address - Country:US
Mailing Address - Phone:762-323-7745
Mailing Address - Fax:
Practice Address - Street 1:262 E LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3808
Practice Address - Country:US
Practice Address - Phone:762-323-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional