Healthcare Provider Details

I. General information

NPI: 1114656451
Provider Name (Legal Business Name): MARIANNE COELHO MCCOWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MCGINNIS FERRY RD APT 1717
SUWANEE GA
30024-3836
US

IV. Provider business mailing address

4000 MCGINNIS FERRY RD APT 1717
SUWANEE GA
30024-3836
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-8984
  • Fax:
Mailing address:
  • Phone: 786-600-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016532
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: