Healthcare Provider Details

I. General information

NPI: 1962866814
Provider Name (Legal Business Name): TAMELA RENEE MCDONALD LPC, CPCS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 SATELLITE BLVD STE 400
DULUTH GA
30097-4927
US

IV. Provider business mailing address

PO BOX 711
DULUTH GA
30096-0013
US

V. Phone/Fax

Practice location:
  • Phone: 770-696-0837
  • Fax:
Mailing address:
  • Phone: 770-696-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009009
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCMHC19310
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009009
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: