Provider Demographics
NPI:1528377033
Name:MCNAMARA, GERALYN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BLUE MOON XING
Mailing Address - Street 2:APT 434
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9704
Mailing Address - Country:US
Mailing Address - Phone:206-437-1549
Mailing Address - Fax:
Practice Address - Street 1:2591 US HIGHWAY 17
Practice Address - Street 2:SUITE 304
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3864
Practice Address - Country:US
Practice Address - Phone:206-437-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001361OtherGA LICENSED MARRIAGE AND FAMILY THERAPIST NUMBER 001361