Provider Demographics
NPI:1578330239
Name:MAGGARD, MICHIELLE (LPC, CPCS)
Entity Type:Individual
Prefix:
First Name:MICHIELLE
Middle Name:
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N AVONDALE PLZ STE B
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1317
Mailing Address - Country:US
Mailing Address - Phone:404-946-8676
Mailing Address - Fax:
Practice Address - Street 1:17 N AVONDALE PLZ STE B
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1317
Practice Address - Country:US
Practice Address - Phone:404-946-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health