Provider Information for 1124341854
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Dr. ADELINE MCTAVOUS Ph.D., LPC, LMHC,CCS
Sex: Female
NPI: 1124341854
Last Updated: 2018-09-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124341854 | ||||||||
| Enumeration Date | 2010-03-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 555 CHARLIE SMITH SR HWY STE 6 SAINT MARYS, GA 31558-3032 United States Phone: 912-576-0187 | Fax:912-576-9690 | ||||||||
| Primary Practice Address | 555 CHARLIE SMITH SR HWY STE 6 SAINT MARYS, GA 31558 United States Phone: 912-576-0187 | Fax:912-576-9690 | ||||||||
| Secondary Practice Address(es) | 1205 4TH ST | ||||||||
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