Individual
LANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW006563
Contact information
Practice address
1145 PINE LAKE DR, GRAYSON, GA 30017-7926
(404) 522-3100
Mailing address
1105 GREGG HWY, AIKEN, SC 29801-6341
(803) 649-1900
(803) 643-2926
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570569761
TAX ID
SC
05
—
AD01AK
—
SC
Enumeration date
01/06/2015
Last updated
11/04/2020
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