Provider Demographics
NPI:1164460895
Name:MICHALOPOULOU, GEORGIA (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:MICHALOPOULOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43228 RHINELAND DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1958
Mailing Address - Country:US
Mailing Address - Phone:586-770-2473
Mailing Address - Fax:
Practice Address - Street 1:1560 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1135
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009156103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist