Provider Demographics
NPI:1700016953
Name:MCDONALD, KAREN JORENE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JORENE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHILOH RD NW
Mailing Address - Street 2:SUITE 610
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7147
Mailing Address - Country:US
Mailing Address - Phone:678-525-5177
Mailing Address - Fax:770-926-9696
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:SUITE 610
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:678-525-5177
Practice Address - Fax:770-926-9696
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04033451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health