Provider Demographics
NPI:1215205794
Name:FREDERICK, DANA CAROL (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:CAROL
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5011
Mailing Address - Country:US
Mailing Address - Phone:678-381-3493
Mailing Address - Fax:
Practice Address - Street 1:2024 POWERS FERRY RD SE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5011
Practice Address - Country:US
Practice Address - Phone:678-381-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006591101YP2500X
GAMFT001236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional