Provider Demographics
NPI:1033269964
Name:MICKLER, JOSEPH BAISDEN III (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BAISDEN
Last Name:MICKLER
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
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Mailing Address - Street 1:3094 NOAH CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6258
Mailing Address - Country:US
Mailing Address - Phone:770-851-7988
Mailing Address - Fax:678-574-9585
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:#305
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:770-445-6358
Practice Address - Fax:770-445-7262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC003204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional