Provider Demographics
NPI:1912937152
Name:MCDONALD, MARTY GAARN (LCSW, MS)
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:GAARN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:GAARN
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW,MS
Mailing Address - Street 1:974 ROSEDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4831
Mailing Address - Country:US
Mailing Address - Phone:404-872-9026
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-329-4622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical