Provider Demographics
NPI:1275394082
Name:MCCOY, PAUL (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 FLYING SPUR DR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2808
Mailing Address - Country:US
Mailing Address - Phone:470-844-1362
Mailing Address - Fax:
Practice Address - Street 1:2173 FLYING SPUR DR
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30058-2808
Practice Address - Country:US
Practice Address - Phone:470-844-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0089321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical