Provider Demographics
NPI:1366451262
Name:MCDONALD, SALLY S (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:MCDONALD
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 1:2350 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2601
Mailing Address - Country:US
Mailing Address - Phone:770-885-2597
Mailing Address - Fax:770-457-3080
Practice Address - Street 1:2801 BUFORD HWY NE STE 505
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2124
Practice Address - Country:US
Practice Address - Phone:770-885-2597
Practice Address - Fax:770-457-3080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor