Healthcare Provider Details

I. General information

NPI: 1659283802
Provider Name (Legal Business Name): TAMATHA MCCOY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PLACE STE R
MARIETTA GA
30008-5310
US

IV. Provider business mailing address

1390 PARK BROOKE CIR SW
MARIETTA GA
30008-5310
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-4548
  • Fax:
Mailing address:
  • Phone: 404-941-4548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: