Provider Demographics
NPI:1801435888
Name:SMITH, CALVIN KITTRELL (LPC)
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:KITTRELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 COBB PKWY SE APT 9C
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2708
Mailing Address - Country:US
Mailing Address - Phone:678-878-1548
Mailing Address - Fax:
Practice Address - Street 1:2350 COBB PKWY SE APT 9C
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2708
Practice Address - Country:US
Practice Address - Phone:678-878-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007034821101YP2500X
SC6761101YP2500X
GALPC009336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional