Healthcare Provider Details

I. General information

NPI: 1023327525
Provider Name (Legal Business Name): IJUANA MCCAIN LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IJUANA MCCAIN LAPC

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 BRECKINRIDGE BLVD STE 116
DULUTH GA
30096-4932
US

IV. Provider business mailing address

3550 CENTERVILLE HWY 107 #120
SNELLVILLE GA
30039-4133
US

V. Phone/Fax

Practice location:
  • Phone: 770-495-9775
  • Fax: 770-495-9745
Mailing address:
  • Phone: 404-314-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: