Provider Information for 1093552143
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Mrs. SHANIQUA SMITH LCSW
Sex: Female
NPI: 1093552143
Last Updated: 2024-07-24
Certification Date: 2024-07-24
Certification Date: 2024-07-24
Details
| Name | Value | ||||||||
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| NPI | 1093552143 | ||||||||
| Enumeration Date | 2024-07-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 75 WASHINGTON ST #111 FAIRBURN, GA 30213-9998 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 75 WASHINGTON ST #111 FAIRBURN, GA 30213-9998 United States Phone: 470-485-3587 | Fax: | ||||||||
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