Provider Demographics
NPI:1497310965
Name:CHARNLEY, MICHAEL J (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CHARNLEY
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 1:296 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1973
Mailing Address - Country:US
Mailing Address - Phone:706-974-0359
Mailing Address - Fax:
Practice Address - Street 1:296 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1973
Practice Address - Country:US
Practice Address - Phone:706-974-0359
Practice Address - Fax:404-393-5754
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC010672OtherSTATE LPC LICENSE NUMBER