Healthcare Provider Details

I. General information

NPI: 1205338514
Provider Name (Legal Business Name): MLC CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 LAKE PARK DR SE APT E
SMYRNA GA
30080-7635
US

IV. Provider business mailing address

2075 LAKE PARK DR SE APT E
SMYRNA GA
30080-7635
US

V. Phone/Fax

Practice location:
  • Phone: 404-922-1628
  • Fax:
Mailing address:
  • Phone: 470-464-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW6112
License Number StateGA

VIII. Authorized Official

Name: MS. MARGARET LADELL CONLEY
Title or Position: CEO
Credential: LCSW
Phone: 470-464-0090