Provider Demographics
NPI:1568042752
Name:CHRISTOFORO, MICHELLE Y (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:CHRISTOFORO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CAMBRAY CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3503
Mailing Address - Country:US
Mailing Address - Phone:904-200-2258
Mailing Address - Fax:
Practice Address - Street 1:4499 GA HIGHWAY 40 E STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9402
Practice Address - Country:US
Practice Address - Phone:904-676-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional