Provider Demographics
NPI:1548380363
Name:RECTOR, MICHAEL DEWAYNE (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:RECTOR
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HARLEY LN
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7391
Mailing Address - Country:US
Mailing Address - Phone:706-965-9997
Mailing Address - Fax:706-965-9999
Practice Address - Street 1:35 HARLEY LN
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7391
Practice Address - Country:US
Practice Address - Phone:706-965-9997
Practice Address - Fax:706-965-9999
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional