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General NPI Number Information
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NPI Number | 1184167637
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Entity Type | Organization
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Legal Business Name | LENA M. MCMANUS, EDS LPC NCC LLC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 41 MUSCADINE CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5412
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Country | US
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Telephone | 678-557-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 41 MUSCADINE CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5412
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Country | US
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Telephone | 678-557-2676
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST
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Name | MRS. PALENENA M MCMANUS
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Credential | LPC
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Telephone | 678-557-2676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LPC006907
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License Number State | GA
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