Provider Demographics
NPI:1619331881
Name:RUIZ, MICHELE (APC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 DAWSON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1259
Mailing Address - Country:US
Mailing Address - Phone:770-326-8086
Mailing Address - Fax:
Practice Address - Street 1:4241 HAYWATER CV
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7178
Practice Address - Country:US
Practice Address - Phone:770-354-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional