Healthcare Provider Details

I. General information

NPI: 1225263718
Provider Name (Legal Business Name): CAMILLE MCDANIEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 PALLADIAN VILLAGE DR STE 320
MARIETTA GA
30066-8204
US

IV. Provider business mailing address

2378 WHITES RDG
DECATUR GA
30034-1110
US

V. Phone/Fax

Practice location:
  • Phone: 770-792-0079
  • Fax: 888-394-1986
Mailing address:
  • Phone: 678-234-5078
  • Fax: 888-394-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005124
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: