MEDICARE: MARY RADER 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	101YM0800X	Mental Health Counselor	LPC012563	GA

General Provider Information

NPI Number	:	1366038903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RADER LPC

Provider Business Mailing Address
First Line	:	120 ACKLIN LN
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-0107
Country	:	US
Telephone Number	:	770-367-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 BURNT HICKORY RD NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1324
Country	:	US
Telephone Number	:	706-888-8222
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	03/11/2026

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