Provider Demographics
NPI:1093940801
Name:MCHAN, PAMELA GAIL (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GAIL
Last Name:MCHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 OFFICE PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6935
Mailing Address - Country:US
Mailing Address - Phone:678-838-8333
Mailing Address - Fax:
Practice Address - Street 1:8303 OFFICE PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6935
Practice Address - Country:US
Practice Address - Phone:678-838-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA125772845BMedicaid