Provider Demographics
NPI:1366226714
Name:SMITH, ROBERT EARL II (MS, LAPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:SMITH
Suffix:II
Gender:M
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY STE C395
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3731
Mailing Address - Country:US
Mailing Address - Phone:678-740-3757
Mailing Address - Fax:678-405-3259
Practice Address - Street 1:3400 OLD MILTON PKWY STE C395
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3731
Practice Address - Country:US
Practice Address - Phone:678-740-3757
Practice Address - Fax:678-405-3529
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional