Healthcare Provider Details

I. General information

NPI: 1437646106
Provider Name (Legal Business Name): CAITLIN DODD DONAHUE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 420
MARIETTA GA
30060-1171
US

IV. Provider business mailing address

258 MOUNTAIN VIEW RD NW
MARIETTA GA
30064-2116
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-6760
  • Fax:
Mailing address:
  • Phone: 404-357-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: