Provider Demographics
NPI:1083002620
Name:COLLIER, MICHAL ANGELIQUE
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:ANGELIQUE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371218
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-1218
Mailing Address - Country:US
Mailing Address - Phone:404-593-9921
Mailing Address - Fax:404-596-8583
Practice Address - Street 1:4246 MOUNTAIN GLEN TRCE
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6475
Practice Address - Country:US
Practice Address - Phone:404-593-9921
Practice Address - Fax:404-596-8583
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007771101YP2500X
GA231778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional