Provider Demographics
NPI:1174915623
Name:SMITH, ROSHONDA A
Entity type:Individual
Prefix:
First Name:ROSHONDA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3618
Mailing Address - Country:US
Mailing Address - Phone:404-587-0851
Mailing Address - Fax:
Practice Address - Street 1:5529 REDAN CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3411
Practice Address - Country:US
Practice Address - Phone:404-587-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174400000XOther Service ProvidersSpecialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker