Individual
MICHAEL SCOTT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY
Contact information
Practice address
610 RIDLEY AVE, LAGRANGE, GA 30240-2236
(706) 884-5050
Mailing address
610 RIDLEY AVE, LAGRANGE, GA 30240-2236
(706) 884-5050
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC009754
GA
103TC0700X
Clinical Psychologist
Primary
PSY004636
GA
Other
Enumeration date
09/07/2017
Last updated
01/31/2023
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