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NPI Code Detail

MEDICARE: DANA CAROL FREDERICK LPC, LMFT

MEDICARE: DANA CAROL FREDERICK LPC, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC006591GA
2106H00000XMarriage & Family TherapistMFT001236GA

General Provider Information

NPI Number : 1215205794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA CAROL FREDERICK LPC, LMFT
Provider Business Mailing Address
First Line : 2024 POWERS FERRY RD SE
Second Line : SUITE 120
City : ATLANTA
State : GA
Zip : 30339-5011
Country : US
Telephone Number : 678-381-3493
Fax Number :
Provider Business Practice Location Address
First Line : 2024 POWERS FERRY RD SE
Second Line : SUITE 120
City : ATLANTA
State : GA
Zip : 30339-5011
Country : US
Telephone Number : 678-381-3493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2011
Last Update Date : 02/14/2015

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Directions to “ DANA CAROL FREDERICK LPC, LMFT” Practice Location

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