Provider Demographics
NPI:1225753791
Name:MCDONALD, MARY JEANETTE (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEANETTE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 W SEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7313
Mailing Address - Country:US
Mailing Address - Phone:336-455-3524
Mailing Address - Fax:
Practice Address - Street 1:3008 W SEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7313
Practice Address - Country:US
Practice Address - Phone:336-455-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15929101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty