Provider Demographics
NPI:1962866814
Name:MCDONALD, TAMELA RENEE (LPC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:RENEE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:3235 SATELLITE BLVD STE 400
Practice Address - Street 2:SUITE #300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8688
Practice Address - Country:US
Practice Address - Phone:770-464-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X, 261QM0850X
GALPC009009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health