Provider Demographics
NPI:1497105852
Name:ESTIS, MICHELLE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:F
Last Name:ESTIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WADE AVE
Mailing Address - Street 2:SPRING GROVE HOSPITAL CENTER, DAYHOFF A
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4663
Mailing Address - Country:US
Mailing Address - Phone:410-402-7885
Mailing Address - Fax:410-402-7700
Practice Address - Street 1:55 WADE AVE
Practice Address - Street 2:SPRING GROVE HOSPITAL CENTER, DAYHOFF A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4663
Practice Address - Country:US
Practice Address - Phone:410-402-7885
Practice Address - Fax:410-402-7700
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical