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General NPI Number Information
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NPI Number | 1679870679
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Entity Type | Organization
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Legal Business Name | MCKINNEY COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 3445 BUFFINGTON CENTER
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City | ATLANTA
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State | GA
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Zip | 30349-2941
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Country | US
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Telephone | 404-281-1698
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Fax | 404-968-4562
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Provider Business Mailing Address
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Address Line | 2440 MCCALL CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3093
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Country | US
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Telephone | 404-281-1698
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Fax | 404-968-4562
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TRACEY ADELE MCKINNEY
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Credential | LPC
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Telephone | 404-281-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LPC003685
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC003685
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License Number State | GA
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