Provider Demographics
NPI:1013315365
Name:MCCLARY-MYERS, FREDERICA (LPC)
Entity Type:Individual
Prefix:
First Name:FREDERICA
Middle Name:
Last Name:MCCLARY-MYERS
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 1:1533 WALTON LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3880
Mailing Address - Country:US
Mailing Address - Phone:404-931-2166
Mailing Address - Fax:
Practice Address - Street 1:1533 WALTON LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3880
Practice Address - Country:US
Practice Address - Phone:404-931-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health