Individual
MRS. FAYETTE MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1829 WRIGHTSBORO RD, AUGUSTA, GA 30904-2010
(762) 499-0447
Mailing address
3915 BARNETT XING, AUGUSTA, GA 30909-9206
(706) 833-4469
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
010512
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010512
—
GA
Enumeration date
11/13/2018
Last updated
11/13/2018
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