Provider Demographics
NPI:1962907121
Name:SMITH, SARAH P (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:P
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 1:1300 JOSEPH E BOONE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2032
Mailing Address - Country:US
Mailing Address - Phone:678-843-8805
Mailing Address - Fax:
Practice Address - Street 1:1539 OLD VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-7132
Practice Address - Country:US
Practice Address - Phone:877-755-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical