Provider Demographics
NPI:1053889717
Name:BETH MCDONALD LPC LLC
Entity type:Organization
Organization Name:BETH MCDONALD LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:762-435-4837
Mailing Address - Street 1:2701 SANDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-3221
Mailing Address - Country:US
Mailing Address - Phone:762-435-4837
Mailing Address - Fax:
Practice Address - Street 1:296 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-1388
Practice Address - Country:US
Practice Address - Phone:762-435-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty