Provider Demographics
NPI:1508142928
Name:LAKE, MICHELLE CHRISTINA (LMHC, EDD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CHRISTINA
Last Name:LAKE
Suffix:
Gender:F
Credentials:LMHC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 HARWICK CIR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-7859
Mailing Address - Country:US
Mailing Address - Phone:305-766-1788
Mailing Address - Fax:305-397-1010
Practice Address - Street 1:7900 OAK LN STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6001
Practice Address - Country:US
Practice Address - Phone:305-766-1788
Practice Address - Fax:305-397-1010
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health