Provider Demographics
NPI:1093861213
Name:BRADY, MICHELE WYATT (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:WYATT
Last Name:BRADY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:WYATT
Other - Last Name:IRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3574 HIGHWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2517
Mailing Address - Country:US
Mailing Address - Phone:404-910-3868
Mailing Address - Fax:
Practice Address - Street 1:3574 HIGHWOOD DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2517
Practice Address - Country:US
Practice Address - Phone:404-910-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional