MEDICARE: MR. WILLIAM CLARK MAHAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC005723	GA

General Provider Information

NPI Number	:	1194937276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CLARK MAHAN LPC

Provider Business Mailing Address
First Line	:	34 LENOX POINTE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3169
Country	:	US
Telephone Number	:	404-229-6177
Fax Number	:	855-702-2499

Provider Business Practice Location Address
First Line	:	34 LENOX POINTE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3169
Country	:	US
Telephone Number	:	404-229-6177
Fax Number	:	855-702-2499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/15/2023

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