Provider Demographics
NPI:1497061394
Name:DREW, MICHELLE (MEDM CAGS, LPC)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:MEDM CAGS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-0304
Mailing Address - Country:US
Mailing Address - Phone:781-635-0598
Mailing Address - Fax:860-923-3730
Practice Address - Street 1:26 CHASE RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277-2802
Practice Address - Country:US
Practice Address - Phone:781-635-0598
Practice Address - Fax:860-923-3730
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT003588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor