Provider Demographics
NPI:1275921496
Name:MEADOWS, MICHELLE (LPC, CPRP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LPC, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13758 HWY 169
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-7202
Mailing Address - Country:US
Mailing Address - Phone:912-764-9868
Mailing Address - Fax:
Practice Address - Street 1:11 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5306
Practice Address - Country:US
Practice Address - Phone:912-764-9868
Practice Address - Fax:912-764-5066
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007892101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor