Healthcare Provider Details

I. General information

NPI: 1235669888
Provider Name (Legal Business Name): DONNA COLLINS MCDANIEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 EXECUTIVE CENTER DR STE 201
MARTINEZ GA
30907-0953
US

IV. Provider business mailing address

9 TEAL CT
NORTH AUGUSTA SC
29841-3276
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-5011
  • Fax: 706-868-5023
Mailing address:
  • Phone: 803-514-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number009576
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: