Healthcare Provider Details

I. General information

NPI: 1114371390
Provider Name (Legal Business Name): MACCONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HIGHLANDS PKWY SE SUITE 110
SMYRNA GA
30082-5131
US

IV. Provider business mailing address

3300 HIGHLANDS PKWY SE SUITE 110
SMYRNA GA
30082-5131
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-9445
  • Fax:
Mailing address:
  • Phone: 770-687-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MCKEISHA WASHINGTON
Title or Position: CEO/OWNER
Credential:
Phone: 770-687-9445