MEDICARE: THE REAL MCCOY THERAPY & CONSULTING LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1467216317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REAL MCCOY THERAPY & CONSULTING LLC

Provider Business Mailing Address
First Line	:	3795 THAMES RD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-1511
Country	:	US
Telephone Number	:	678-799-5257
Fax Number	:

Provider Business Practice Location Address
First Line	:	3795 THAMES RD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-1511
Country	:	US
Telephone Number	:	678-799-5257
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ERICA MCCOY
Credential	:
Telephone Number	:	678-799-5257

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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