MEDICARE: MS. MARY MCKALEIGH COLE LPC

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	101YP2500X	Professional Counselor	LPC011469	GA

General Provider Information

NPI Number	:	1770062218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY MCKALEIGH COLE LPC

Provider Business Mailing Address
First Line	:	PO BOX 1223
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-0024
Country	:	US
Telephone Number	:	678-481-5804
Fax Number	:	678-550-9322

Provider Business Practice Location Address
First Line	:	1350 SCENIC HWY N STE 266
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-7924
Country	:	US
Telephone Number	:	678-481-5804
Fax Number	:	678-550-9322

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

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	11/21/2023

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