Provider Demographics
NPI:1023293925
Name:MCDONOUGH, CALLAHAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CALLAHAN
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 GLEN IRIS DR NE
Mailing Address - Street 2:UNIT # L
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2960
Mailing Address - Country:US
Mailing Address - Phone:404-614-2855
Mailing Address - Fax:
Practice Address - Street 1:455 GLEN IRIS DR NE
Practice Address - Street 2:UNIT # L
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2960
Practice Address - Country:US
Practice Address - Phone:404-614-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical