Provider Demographics
NPI:1538656509
Name:MCDONALD, BRYON M (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:BRYON
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 JOHNSON FERRY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8317
Mailing Address - Country:US
Mailing Address - Phone:678-408-1581
Mailing Address - Fax:770-558-4759
Practice Address - Street 1:2850 JOHNSON FERRY RD STE 250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8317
Practice Address - Country:US
Practice Address - Phone:678-408-1581
Practice Address - Fax:770-558-4759
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7263-125101YM0800X
MN2127101YM0800X
GALPC012271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14236068OtherCAQH