Provider Demographics
NPI:1649577529
Name:PERRY, MICHAEL STUART (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STUART
Last Name:PERRY
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
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Mailing Address - Street 1:805 GLYNN ST S
Mailing Address - Street 2:STE 127#326
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2077
Mailing Address - Country:US
Mailing Address - Phone:678-371-4803
Mailing Address - Fax:678-723-0936
Practice Address - Street 1:220 WERNER WAY
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3615
Practice Address - Country:US
Practice Address - Phone:678-371-4803
Practice Address - Fax:678-723-0936
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC007125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional