MEDICARE: TAMELA RENEE MCDONALD LPC, NCC, CCMHC

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor
3	261QM0850X	Adult Mental Health Clinic/Center
4	101YP2500X	Professional Counselor	LPC009009	GA

General Provider Information

NPI Number	:	1962866814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMELA RENEE MCDONALD LPC, NCC, CCMHC

Provider Business Mailing Address
First Line	:	PO BOX 711
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-0013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 SATELLITE BLVD STE 400
Second Line	:	SUITE #300
City	:	DULUTH
State	:	GA
Zip	:	30096-8688
Country	:	US
Telephone Number	:	770-464-5831
Fax Number	:

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	11/21/2017

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