Provider Demographics
NPI:1265008098
Name:MCCOY, RICKETTA YARBROUGH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RICKETTA
Middle Name:YARBROUGH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:SHELLMAN
Mailing Address - State:GA
Mailing Address - Zip Code:39886-0533
Mailing Address - Country:US
Mailing Address - Phone:229-869-9524
Mailing Address - Fax:
Practice Address - Street 1:2908 HARVEST LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-4555
Practice Address - Country:US
Practice Address - Phone:229-869-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical