Provider Demographics
NPI:1427414390
Name:MICHAEL, SOCROTIFF CARRUTH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SOCROTIFF
Middle Name:CARRUTH
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4938
Mailing Address - Country:US
Mailing Address - Phone:678-886-3325
Mailing Address - Fax:
Practice Address - Street 1:3180 CLAIRMONT RD NE
Practice Address - Street 2:SUITE 704
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1076
Practice Address - Country:US
Practice Address - Phone:678-886-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist