Provider Demographics
NPI:1194937276
Name:MAHAN, WILLIAM CLARK (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLARK
Last Name:MAHAN
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 1:34 LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3169
Mailing Address - Country:US
Mailing Address - Phone:404-229-6177
Mailing Address - Fax:855-702-2499
Practice Address - Street 1:34 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3169
Practice Address - Country:US
Practice Address - Phone:404-229-6177
Practice Address - Fax:855-702-2499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005723101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor