Provider Demographics
NPI:1932487097
Name:MCDONALD, JANET MIMI (LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MIMI
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 1:405 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3746
Mailing Address - Country:US
Mailing Address - Phone:470-798-0202
Mailing Address - Fax:470-410-7602
Practice Address - Street 1:405 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3746
Practice Address - Country:US
Practice Address - Phone:470-798-0202
Practice Address - Fax:470-410-7602
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional