Provider Demographics
NPI:1487043253
Name:ALDEN, MICHELLE (MS, LPC, NCC,CAMS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:ALDEN
Suffix:
Gender:F
Credentials:MS, LPC, NCC,CAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 COMPTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2494
Mailing Address - Country:US
Mailing Address - Phone:850-510-8627
Mailing Address - Fax:
Practice Address - Street 1:1410 COMPTON WOODS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2494
Practice Address - Country:US
Practice Address - Phone:850-510-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional