Provider Demographics
NPI:1962256586
Name:WHITLEY-SMITH, RASHIDA IMAN (APC)
Entity type:Individual
Prefix:
First Name:RASHIDA
Middle Name:IMAN
Last Name:WHITLEY-SMITH
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:RASHIDA
Other - Middle Name:IMAN
Other - Last Name:WHITLEY-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APC
Mailing Address - Street 1:4371 GLENWOOD RD APT I8
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5011
Mailing Address - Country:US
Mailing Address - Phone:470-707-5517
Mailing Address - Fax:
Practice Address - Street 1:4371 GLENWOOD RD APT I8
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5011
Practice Address - Country:US
Practice Address - Phone:470-707-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional