MEDICARE: MS. KELLY ANNE MCCARTHY MS

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1720013188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY ANNE MCCARTHY MS

Provider Business Mailing Address
First Line	:	340 GREEN OAK RDG
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4808
Country	:	US
Telephone Number	:	770-973-3845
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 HIGHWAY 92
Second Line	:	SUITE 110
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5235
Country	:	US
Telephone Number	:	770-926-0005
Fax Number	:	770-926-0762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/03/2007

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