Individual
ORIGINAL MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CACI,CACII
Contact information
Practice address
159 FORSYTH ST SW, ATLANTA, GA 30303-3634
(404) 523-4599
(404) 586-0645
Mailing address
159 FORSYTH ST SW, ATLANTA, GA 30303-3634
(404) 523-4599
(404) 586-0645
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3026
GA
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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