Provider Demographics
NPI:1174782452
Name:SMITH, MICHELE S (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORPORATE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4129
Mailing Address - Country:US
Mailing Address - Phone:770-968-6464
Mailing Address - Fax:770-968-6465
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4180
Practice Address - Country:US
Practice Address - Phone:770-968-6380
Practice Address - Fax:770-968-6465
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001178106H00000X
CAMFC43092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist