Provider Demographics
NPI:1417173428
Name:FRAZIER, MICHAEL A (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 VINCENT MILL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6476
Mailing Address - Country:US
Mailing Address - Phone:678-697-8634
Mailing Address - Fax:
Practice Address - Street 1:1827 POWERS FERRY RD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5621
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:770-953-4640
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional