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General NPI Number Information
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NPI Number | 1215277553
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Entity Type | Individual
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Provider Name | SCOTT DOUGLAS MCDANIEL LPC
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Gender | Male
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Dates
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Enumeration Date | 02/24/2013
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 808 AVENUE B NE STE D
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City | ROME
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State | GA
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Zip | 30165-2746
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Country | US
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Telephone | 706-331-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 808 AVENUE B NE STE D
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City | ROME
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State | GA
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Zip | 30165-2746
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Country | US
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Telephone | 706-331-1757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004274
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License Number State | GA
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