Provider Demographics
NPI:1639684533
Name:MATLOCK RESOURCE CENTER, LLC
Entity Type:Organization
Organization Name:MATLOCK RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CCMHC
Authorized Official - Phone:770-464-5831
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 SATELLITE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4927
Practice Address - Country:US
Practice Address - Phone:770-464-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMELA R MCDONALD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health