Provider Demographics
NPI:1013127661
Name:STROUD-MCCOTTRIE, VERONICA KHADIJAH (NCAC II, CCS, SAM)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:KHADIJAH
Last Name:STROUD-MCCOTTRIE
Suffix:
Gender:F
Credentials:NCAC II, CCS, SAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GREEN COMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016
Mailing Address - Country:US
Mailing Address - Phone:770-356-3685
Mailing Address - Fax:678-342-4073
Practice Address - Street 1:215 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3318
Practice Address - Country:US
Practice Address - Phone:678-729-9900
Practice Address - Fax:678-729-9904
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1725-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)