Provider Demographics
NPI:1225141930
Name:SIRCH, MICHELLE LY NN (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LY NN
Last Name:SIRCH
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 DUNLORA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-0640
Mailing Address - Country:US
Mailing Address - Phone:434-882-4489
Mailing Address - Fax:434-977-8878
Practice Address - Street 1:1710 ALLIED ST STE 22
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5341
Practice Address - Country:US
Practice Address - Phone:434-977-8877
Practice Address - Fax:434-977-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
VA0701002983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5410746Medicaid