Individual
DR. MICHELLE R. HENRIQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., LCSW, LCDC
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(404) 644-1225
Mailing address
71 PORTICO PL, NEWNAN, GA 30265-5944
(404) 644-1225
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11588
TX
1041C0700X
Clinical Social Worker
Primary
55290
TX
1041C0700X
Clinical Social Worker
SW23402
FL
Other
Enumeration date
03/06/2013
Last updated
01/23/2025
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