Provider Demographics
NPI:1568038610
Name:MICHEL, GEORDACHE
Entity Type:Individual
Prefix:
First Name:GEORDACHE
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 SW 112TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1161
Mailing Address - Country:US
Mailing Address - Phone:954-901-5706
Mailing Address - Fax:
Practice Address - Street 1:8963 SW 112TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1161
Practice Address - Country:US
Practice Address - Phone:954-901-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2022-06-08
Deactivation Date:2021-08-03
Deactivation Code:
Reactivation Date:2022-06-08
Provider Licenses
StateLicense IDTaxonomies
FLMH18849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health