Provider Demographics
NPI:1154618643
Name:MCKAY, PATRICK T (LPC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:T
Last Name:MCKAY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3856
Mailing Address - Country:US
Mailing Address - Phone:586-925-0577
Mailing Address - Fax:770-809-9232
Practice Address - Street 1:203 BAYWOOD LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3856
Practice Address - Country:US
Practice Address - Phone:586-925-0577
Practice Address - Fax:770-809-9232
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X- LPC00610101YP2500X
GA101YS0200X- 723411101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool